- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $478.63 / $3,090.30
| Facility | | $194.98 | $478.63 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $323.59 / $870.96
| Professional | | $199.53 | $323.59 | $870.96 |
- 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
- $338.84 / $660.69 / $1,412.54
| Professional | | $338.84 | $660.69 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,122.02 / $1,778.28
| Facility | | $954.99 | $1,122.02 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $562.34 / $933.25
| Professional | | $263.03 | $562.34 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $645.65 / $3,981.07
| Facility | | $223.87 | $645.65 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $645.65 / $1,047.13
| Professional | | $426.58 | $645.65 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $630.96 / $1,659.59
| Facility | | $229.09 | $630.96 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $602.56 / $1,698.24
| Professional | | $338.84 | $602.56 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $707.95
| Professional | | $32.36 | $33.11 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $891.25 / $2,344.23
| Facility | | $478.63 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $724.44 / $1,023.29
| Professional | | $389.05 | $724.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $676.08 / $1,148.15
| Professional | | $389.05 | $676.08 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,995.26 / $1,995.26
| Facility | | $1,258.93 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $562.34 / $2,570.40
| Professional | | $281.84 | $562.34 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $676.08
| Professional | | $426.58 | $426.58 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $977.24 / $1,513.56
| Professional | | $436.52 | $977.24 | $1,513.56 |
- 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
- $239.88 / $446.68 / $1,148.15
| Professional | | $239.88 | $446.68 | $1,148.15 |