- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $416.87 / $1,905.46
| Facility | | $239.88 | $416.87 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $245.47 / $512.86
| Professional | | $218.78 | $245.47 | $512.86 |
- 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
- $239.88 / $467.74 / $1,148.15
| Professional | | $239.88 | $467.74 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $758.58 / $1,230.27
| Facility | | $660.69 | $758.58 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $630.96 / $1,148.15
| Professional | | $275.42 | $630.96 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $338.84 / $3,162.28
| Facility | | $229.09 | $338.84 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $602.56 / $741.31
| Professional | | $436.52 | $602.56 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $1,584.89
| Facility | | $229.09 | $380.19 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $478.63 / $1,819.70
| Professional | | $229.09 | $478.63 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $288.40
| Professional | | $32.36 | $33.11 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $891.25 / $2,344.23
| Facility | | $457.09 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $562.34 / $1,000.00
| Professional | | $309.03 | $562.34 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $645.65 / $912.01
| Professional | | $436.52 | $645.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $630.96 / $1,995.26
| Facility | | $263.03 | $630.96 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $1,047.13
| Facility | 54 | $446.68 | $446.68 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,122.02 / $1,778.28
| Professional | | $398.11 | $1,122.02 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Professional | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,548.82 / $1,584.89
| Professional | | $269.15 | $1,548.82 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,584.89 / $2,187.76
| Facility | | $977.24 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $346.74 / $933.25
| Professional | | $223.87 | $346.74 | $933.25 |