- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,071.52 / $2,818.38
| Facility | | $398.11 | $1,071.52 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $478.63 / $724.44
| Professional | | $371.54 | $478.63 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,995.26 / $3,630.78
| Facility | | $776.25 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $331.13 / $812.83
| Professional | | $5.01 | $331.13 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $602.56 / $602.56
| Facility | | $79.43 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,288.25 / $2,630.27
| Facility | | $426.58 | $1,288.25 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $602.56 / $1,096.48
| Professional | | $302.00 | $602.56 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $4,466.84 / $4,466.84
| Professional | | $3,019.95 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $602.56 / $1,148.15
| Facility | | $426.58 | $602.56 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $512.86 / $933.25
| Professional | | $331.13 | $512.86 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Professional | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $645.65 / $1,288.25
| Professional | | $602.56 | $645.65 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $602.56 / $1,584.89
| Facility | | $426.58 | $602.56 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $602.56 / $1,096.48
| Professional | | $302.00 | $602.56 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $602.56 / $724.44
| Facility | | $107.15 | $602.56 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $251.19 / $380.19
| Professional | | $38.02 | $251.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $602.56
| Professional | | $234.42 | $309.03 | $602.56 |