- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $977.24 / $3,715.35
| Facility | | $524.81 | $977.24 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $489.78 / $1,023.29
| Professional | | $309.03 | $489.78 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $776.25 / $1,047.13
| Facility | | $524.81 | $776.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $524.81 / $691.83
| Professional | | $446.68 | $524.81 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,202.26 / $1,348.96
| Facility | | $537.03 | $1,202.26 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $549.54 / $707.95
| Professional | | $263.03 | $549.54 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $645.65 / $1,621.81
| Facility | | $524.81 | $645.65 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $660.69 / $1,479.11
| Professional | | $524.81 | $660.69 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $1,047.13
| Facility | | $524.81 | $524.81 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Professional | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $831.76 / $1,621.81
| Facility | | $524.81 | $831.76 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $630.96
| Professional | | $467.74 | $467.74 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $776.25 / $1,380.38
| Facility | | $602.56 | $776.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $524.81 / $691.83
| Professional | | $446.68 | $524.81 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $630.96 / $630.96
| Facility | | $524.81 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $588.84
| Professional | | $218.78 | $218.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $524.81 / $933.25
| Professional | | $234.42 | $524.81 | $933.25 |