- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $416.87 / $3,090.30
| Facility | | $165.96 | $416.87 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $295.12 / $691.83
| Professional | | $173.78 | $295.12 | $691.83 |
- 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
- $316.23 / $575.44 / $1,318.26
| Professional | | $316.23 | $575.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,071.52 / $1,698.24
| Facility | | $912.01 | $1,071.52 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $524.81 / $912.01
| Professional | | $229.09 | $524.81 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $562.34 / $3,981.07
| Facility | | $194.98 | $562.34 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $602.56 / $1,000.00
| Professional | | $363.08 | $602.56 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $562.34 / $1,659.59
| Facility | | $199.53 | $562.34 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $575.44 / $1,479.11
| Professional | | $323.59 | $575.44 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $676.08
| Professional | | $32.36 | $33.11 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $891.25 / $2,344.23
| Facility | | $407.38 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $707.95 / $954.99
| Professional | | $371.54 | $707.95 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $588.84 / $1,122.02
| Professional | | $331.13 | $588.84 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,187.76 / $2,187.76
| Facility | | $1,258.93 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $501.19 / $2,454.71
| Professional | | $239.88 | $501.19 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $645.65
| Professional | | $371.54 | $371.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $851.14 / $1,479.11
| Professional | | $380.19 | $851.14 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,659.59 / $2,570.40
| Facility | | $1,023.29 | $1,659.59 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $407.38 / $1,096.48
| Professional | | $213.80 | $407.38 | $1,096.48 |