- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $478.63 / $3,090.30
| Facility | | $229.09 | $478.63 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $302.00 / $794.33
| Professional | | $223.87 | $302.00 | $794.33 |
- 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
- $288.40 / $446.68 / $1,148.15
| Professional | | $288.40 | $446.68 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $954.99 / $1,513.56
| Facility | | $812.83 | $954.99 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $794.33 / $1,445.44
| Professional | | $346.74 | $794.33 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $467.74 / $3,162.28
| Facility | | $251.19 | $467.74 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $616.60 / $870.96
| Professional | | $426.58 | $616.60 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $489.78 / $1,584.89
| Facility | | $251.19 | $489.78 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $616.60 / $3,890.45
| Professional | | $316.23 | $616.60 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $309.03
| Professional | | $32.36 | $33.11 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $891.25 / $2,344.23
| Facility | | $467.74 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $707.95 / $1,047.13
| Professional | | $389.05 | $707.95 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $851.14 / $1,318.26
| Professional | | $512.86 | $851.14 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $602.56 / $1,479.11
| Facility | | $263.03 | $602.56 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,445.44 / $3,890.45
| Professional | | $416.87 | $1,445.44 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $977.24
| Professional | | $758.58 | $758.58 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,479.11 / $1,995.26
| Professional | | $954.99 | $1,479.11 | $1,995.26 |
- 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
- $263.03 / $436.52 / $1,071.52
| Professional | | $263.03 | $436.52 | $1,071.52 |