- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $758.58 / $3,388.44
| Facility | | $354.81 | $758.58 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $407.38 / $870.96
| Professional | | $338.84 | $407.38 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,090.30 / $5,754.40
| Facility | | $2,187.76 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $691.83 / $1,737.80
| Professional | | $371.54 | $691.83 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,258.93 / $2,041.74
| Facility | | $1,096.48 | $1,258.93 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,000.00 / $1,862.09
| Professional | | $426.58 | $1,000.00 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $562.34 / $3,162.28
| Facility | | $323.59 | $562.34 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $912.01 / $1,148.15
| Professional | | $676.08 | $912.01 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $602.56 / $1,584.89
| Facility | | $323.59 | $602.56 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $794.33 / $3,019.95
| Professional | | $398.11 | $794.33 | $3,019.95 |
- 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
- $512.86 / $933.25 / $1,584.89
| Professional | | $512.86 | $933.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,023.29 / $1,548.82
| Professional | | $645.65 | $1,023.29 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,238.72 / $2,238.72
| Facility | | $954.99 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,862.09 / $2,951.21
| Professional | | $588.84 | $1,862.09 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,288.25
| Professional | | $1,148.15 | $1,148.15 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $2,344.23 / $2,630.27
| Professional | | $269.15 | $2,344.23 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,584.89 / $2,630.27
| Facility | | $1,000.00 | $1,584.89 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $1,479.11
| Professional | | $354.81 | $562.34 | $1,479.11 |