- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $446.68 / $812.83
| Facility | | $389.05 | $446.68 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $457.09 / $1,122.02
| Professional | | $346.74 | $457.09 | $1,122.02 |
- 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
- $363.08 / $691.83 / $1,737.80
| Professional | | $363.08 | $691.83 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,230.27 / $1,949.84
| Facility | | $1,047.13 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $933.25 / $1,862.09
| Professional | | $426.58 | $933.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $549.54 / $3,162.28
| Facility | | $323.59 | $549.54 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $912.01 / $1,122.02
| Professional | | $676.08 | $912.01 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $575.44 / $1,584.89
| Facility | | $323.59 | $575.44 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $794.33 / $2,951.21
| Professional | | $389.05 | $794.33 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $446.68
| Professional | | $32.36 | $33.11 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $891.25 / $2,344.23
| Facility | | $691.83 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $912.01 / $1,584.89
| Professional | | $489.78 | $912.01 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,023.29 / $1,445.44
| Professional | | $645.65 | $1,023.29 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $933.25 / $3,467.37
| Facility | | $263.03 | $933.25 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $1,584.89
| Facility | 54 | $660.69 | $660.69 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,819.70 / $2,884.03
| Professional | | $588.84 | $1,819.70 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,258.93
| Professional | | $1,148.15 | $1,148.15 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,290.87 / $2,511.89
| Professional | | $398.11 | $2,290.87 | $2,511.89 |
- 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
- $85.11 / $645.65 / $2,290.87
| Professional | | $85.11 | $645.65 | $2,290.87 |