- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $3,801.89 / $8,317.64
| Facility | | $407.38 | $3,801.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $416.87 / $1,258.93
| Professional | | $275.42 | $416.87 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Professional | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,890.45 / $38,904.51
| Facility | | $2,570.40 | $3,890.45 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $57,543.99
| Facility | | $3,801.89 | $3,801.89 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $724.44
| Professional | | $263.03 | $407.38 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $724.44 / $794.33
| Professional | | $478.63 | $724.44 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $512.86 / $758.58
| Professional | | $288.40 | $512.86 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,467.37 / $7,585.78
| Facility | | $1,995.26 | $3,467.37 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $446.68 / $446.68
| Professional | | $316.23 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,019.95 / $19,054.61
| Facility | | $1,995.26 | $3,019.95 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,584.89 / $6,606.93
| Facility | | $389.05 | $1,584.89 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $407.38 / $812.83
| Professional | | $275.42 | $407.38 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $758.58 / $1,778.28
| Professional | | $338.84 | $758.58 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $389.05 / $436.52
| Facility | | $154.88 | $389.05 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $407.38 / $467.74
| Professional | | $288.40 | $407.38 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,951.21 / $5,888.44
| Facility | | $1,000.00 | $2,951.21 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $398.11 / $707.95
| Professional | | $257.04 | $398.11 | $707.95 |