- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $776.25 / $1,819.70
| Facility | | $275.42 | $776.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $691.83
| Professional | | $218.78 | $338.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $416.87
| Professional | | $295.12 | $295.12 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,230.27 / $2,290.87
| Facility | | $457.09 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $229.09 / $562.34
| Professional | | $5.01 | $229.09 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $645.65 / $2,511.89
| Facility | | $309.03 | $645.65 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $416.87 / $588.84
| Professional | | $295.12 | $416.87 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $537.03 / $537.03
| Facility | | $416.87 | $537.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $954.99 / $2,089.30
| Facility | | $446.68 | $954.99 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $288.40 / $851.14
| Professional | | $234.42 | $288.40 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,090.30 / $3,090.30
| Professional | | $2,089.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $457.09 / $1,584.89
| Facility | | $295.12 | $457.09 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $371.54 / $676.08
| Professional | | $218.78 | $371.54 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $416.87
| Professional | | $346.74 | $346.74 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,862.09 / $2,454.71
| Facility | | $1,698.24 | $1,862.09 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $501.19 / $1,621.81
| Facility | | $302.00 | $501.19 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $389.05 / $812.83
| Professional | | $234.42 | $389.05 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $416.87 / $501.19
| Facility | | $194.98 | $416.87 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $239.88 / $478.63
| Professional | | $173.78 | $239.88 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $288.40 / $416.87
| Professional | | $162.18 | $288.40 | $416.87 |