- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $954.99 / $1,905.46
| Facility | | $446.68 | $954.99 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $489.78 / $1,258.93
| Professional | | $416.87 | $489.78 | $1,258.93 |
- 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
- $457.09 / $870.96 / $2,187.76
| Professional | | $457.09 | $870.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,513.56 / $2,454.71
| Facility | | $1,318.26 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,230.27 / $2,187.76
| Professional | | $537.03 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $676.08 / $3,162.28
| Facility | | $457.09 | $676.08 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,148.15 / $1,445.44
| Professional | | $851.14 | $1,148.15 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $691.83 / $1,737.80
| Facility | | $457.09 | $691.83 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,000.00 / $3,630.78
| Professional | | $489.78 | $1,000.00 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $575.44
| Professional | | $32.36 | $33.11 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $891.25 / $2,344.23
| Facility | | $831.76 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,148.15 / $1,995.26
| Professional | | $616.60 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,258.93 / $1,778.28
| Professional | | $812.83 | $1,258.93 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,202.26 / $2,884.03
| Facility | | $263.03 | $1,202.26 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,290.87 / $3,630.78
| Professional | | $741.31 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,584.89
| Professional | | $1,479.11 | $1,479.11 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,951.21 / $3,162.28
| Professional | | $1,023.29 | $2,951.21 | $3,162.28 |
- 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
- $457.09 / $691.83 / $1,862.09
| Professional | | $457.09 | $691.83 | $1,862.09 |