- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $741.31 / $1,071.52
| Facility | | $338.84 | $741.31 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $457.09 / $741.31
| Professional | | $363.08 | $457.09 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $1,905.46
| Facility | | $954.99 | $954.99 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $1,548.82
| Professional | | $501.19 | $501.19 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $776.25 / $776.25
| Facility | | $724.44 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Professional | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $53,703.18
| Facility | | $691.83 | $691.83 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $1,258.93
| Professional | | $512.86 | $512.86 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,548.82 / $3,630.78
| Facility | | $954.99 | $1,548.82 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $954.99 / $1,819.70
| Professional | | $588.84 | $954.99 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $776.25
| Facility | | $724.44 | $724.44 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $588.84 / $724.44
| Professional | | $562.34 | $588.84 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $50,118.72 / $75,857.76
| Facility | | $1,584.89 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $912.01 / $912.01
| Professional | | $616.60 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $616.60 / $2,511.89
| Facility | | $346.74 | $616.60 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $616.60 / $1,584.89
| Professional | | $309.03 | $616.60 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $575.44 / $776.25
| Facility | | $562.34 | $575.44 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $588.84 / $724.44
| Professional | | $562.34 | $588.84 | $724.44 |