- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $912.01 / $4,466.84
| Facility | | $398.11 | $912.01 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $398.11 / $831.76
| Professional | | $331.13 | $398.11 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $954.99
| Professional | | $457.09 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $524.81
| Professional | | $416.87 | $416.87 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $660.69 / $660.69
| Facility | | $309.03 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $758.58 / $1,071.52
| Professional | | $575.44 | $758.58 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $501.19 / $758.58
| Professional | | $371.54 | $501.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $537.03 / $933.25
| Facility | | $323.59 | $537.03 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $467.74 / $501.19
| Professional | | $407.38 | $467.74 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $616.60 / $1,096.48
| Facility | | $407.38 | $616.60 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $616.60 / $1,096.48
| Professional | | $407.38 | $616.60 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $562.34 / $575.44
| Facility | | $288.40 | $562.34 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $371.54 / $588.84
| Professional | | $354.81 | $371.54 | $588.84 |