- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $467.74 / $1,202.26
| Facility | | $316.23 | $467.74 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $933.25
| Professional | | $302.00 | $416.87 | $933.25 |
- 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 / $630.96 / $1,548.82
| Professional | | $316.23 | $630.96 | $1,548.82 |
- 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
- $380.19 / $891.25 / $1,621.81
| Professional | | $380.19 | $891.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $489.78 / $3,162.28
| Facility | | $302.00 | $489.78 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $812.83 / $1,023.29
| Professional | | $616.60 | $812.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $537.03 / $1,584.89
| Facility | | $302.00 | $537.03 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $660.69 / $2,570.40
| Professional | | $338.84 | $660.69 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $389.05
| Professional | | $32.36 | $33.11 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $891.25 / $2,344.23
| Facility | | $616.60 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $794.33 / $1,348.96
| Professional | | $436.52 | $794.33 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $891.25 / $1,258.93
| Professional | | $602.56 | $891.25 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $851.14 / $2,041.74
| Facility | | $263.03 | $851.14 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $1,412.54
| Facility | 54 | $602.56 | $602.56 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,584.89 / $2,511.89
| Professional | | $562.34 | $1,584.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,096.48
| Professional | | $1,047.13 | $1,047.13 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $2,089.30 / $2,187.76
| Professional | | $316.23 | $2,089.30 | $2,187.76 |
- 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
- $89.13 / $851.14 / $2,041.74
| Professional | | $89.13 | $851.14 | $2,041.74 |