- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $562.34 / $1,905.46
| Facility | | $263.03 | $562.34 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $288.40 / $758.58
| Professional | | $245.47 | $288.40 | $758.58 |
- 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
- $263.03 / $512.86 / $1,288.25
| Professional | | $263.03 | $512.86 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $870.96 / $1,380.38
| Facility | | $741.31 | $870.96 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $724.44 / $1,258.93
| Professional | | $309.03 | $724.44 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $398.11 / $3,162.28
| Facility | | $251.19 | $398.11 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $676.08 / $851.14
| Professional | | $501.19 | $676.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $436.52 / $1,584.89
| Facility | | $251.19 | $436.52 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $562.34 / $2,089.30
| Professional | | $275.42 | $562.34 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $331.13
| Professional | | $32.36 | $33.11 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $891.25 / $2,344.23
| Facility | | $512.86 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $645.65 / $1,122.02
| Professional | | $354.81 | $645.65 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $724.44 / $1,023.29
| Professional | | $489.78 | $724.44 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $707.95 / $1,995.26
| Facility | | $263.03 | $707.95 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $1,174.90
| Facility | 54 | $489.78 | $489.78 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,288.25 / $2,041.74
| Professional | | $457.09 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $891.25
| Professional | | $851.14 | $851.14 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,737.80 / $1,778.28
| Professional | | $204.17 | $1,737.80 | $1,778.28 |
- 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
- $95.50 / $691.83 / $1,621.81
| Professional | | $95.50 | $691.83 | $1,621.81 |