- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $776.25 / $3,090.30
| Facility | | $316.23 | $776.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $1,000.00
| Professional | | $316.23 | $489.78 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,047.13 / $2,187.76
| Professional | | $537.03 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,778.28 / $2,884.03
| Facility | | $1,548.82 | $1,778.28 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $933.25 / $1,548.82
| Professional | | $426.58 | $933.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,047.13 / $3,981.07
| Facility | | $371.54 | $1,047.13 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,047.13 / $1,698.24
| Professional | | $691.83 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,023.29 / $1,778.28
| Facility | | $407.38 | $1,023.29 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $851.14 / $2,818.38
| Professional | | $524.81 | $851.14 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,071.52
| Professional | | $32.36 | $33.11 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $891.25 / $2,344.23
| Facility | | $758.58 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,202.26 / $1,698.24
| Professional | | $630.96 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,148.15 / $2,041.74
| Professional | | $676.08 | $1,148.15 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $2,630.27 / $2,630.27
| Facility | | $977.24 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $912.01 / $4,168.69
| Professional | | $436.52 | $912.01 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $1,096.48
| Professional | | $707.95 | $707.95 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,621.81 / $2,454.71
| Professional | | $676.08 | $1,621.81 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,584.89 / $2,187.76
| Facility | | $1,023.29 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $741.31 / $1,819.70
| Professional | | $389.05 | $741.31 | $1,819.70 |