- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $426.58 / $724.44
| Facility | | $239.88 | $426.58 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $295.12 / $758.58
| Professional | | $239.88 | $295.12 | $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
- $269.15 / $512.86 / $1,288.25
| Professional | | $269.15 | $512.86 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $933.25 / $1,479.11
| Facility | | $794.33 | $933.25 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $707.95 / $1,380.38
| Professional | | $316.23 | $707.95 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $416.87 / $3,162.28
| Facility | | $245.47 | $416.87 | $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
- $245.47 / $426.58 / $1,584.89
| Facility | | $245.47 | $426.58 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $588.84 / $2,238.72
| Professional | | $281.84 | $588.84 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $323.59
| Professional | | $32.36 | $33.11 | $323.59 |
- 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
- $371.54 / $676.08 / $1,148.15
| Professional | | $371.54 | $676.08 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $851.14 / $1,202.26
| Professional | | $549.54 | $851.14 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $707.95 / $1,659.59
| Facility | | $263.03 | $707.95 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $1,148.15
| Facility | 54 | $489.78 | $489.78 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,348.96 / $2,187.76
| Professional | | $478.63 | $1,348.96 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $933.25
| Professional | | $851.14 | $851.14 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $1,737.80 / $1,905.46
| Professional | | $190.55 | $1,737.80 | $1,905.46 |
- 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 / $537.03 / $1,548.82
| Professional | | $95.50 | $537.03 | $1,548.82 |