- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $954.99 / $1,621.81
| Facility | | $416.87 | $954.99 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $389.05 / $1,258.93
| Professional | | $234.42 | $389.05 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $588.84 / $1,318.26
| Facility | | $380.19 | $588.84 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $416.87 / $1,548.82
| Professional | | $173.78 | $416.87 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,023.29 / $1,479.11
| Facility | | $812.83 | $1,023.29 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $707.95 / $1,621.81
| Facility | | $323.59 | $707.95 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $501.19 / $1,122.02
| Professional | | $251.19 | $501.19 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $562.34 / $3,630.78
| Facility | | $389.05 | $562.34 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $549.54 / $812.83
| Professional | | $457.09 | $549.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $691.83
| Professional | | $416.87 | $416.87 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $478.63 / $478.63
| Facility | | $275.42 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $588.84 / $1,318.26
| Facility | | $380.19 | $588.84 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $416.87 / $1,548.82
| Professional | | $173.78 | $416.87 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $371.54 / $512.86
| Facility | | $218.78 | $371.54 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $676.08
| Facility | | $251.19 | $416.87 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $416.87 / $851.14
| Professional | | $173.78 | $416.87 | $851.14 |