- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $660.69 / $3,090.30
| Facility | | $302.00 | $660.69 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $446.68 / $933.25
| Professional | | $288.40 | $446.68 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,897.79 / $7,585.78
| Facility | | $3,311.31 | $4,897.79 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $630.96 / $1,698.24
| Professional | | $416.87 | $630.96 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,445.44 / $2,290.87
| Facility | | $1,230.27 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,047.13 / $2,187.76
| Professional | | $467.74 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $588.84 / $3,548.13
| Facility | | $316.23 | $588.84 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $851.14 / $1,288.25
| Professional | | $588.84 | $851.14 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $645.65 / $7,244.36
| Facility | | $316.23 | $645.65 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $933.25 / $3,467.37
| Professional | | $467.74 | $933.25 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $398.11
| Professional | | $32.36 | $33.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $5,754.40 / $7,762.47
| Facility | | $616.60 | $5,754.40 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,047.13 / $1,445.44
| Professional | | $575.44 | $1,047.13 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $977.24 / $1,548.82
| Professional | | $575.44 | $977.24 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,235.94 / $4,786.30
| Facility | | $1,737.80 | $3,235.94 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $2,238.72 / $3,388.44
| Professional | | $562.34 | $2,238.72 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,513.56
| Professional | | $1,000.00 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,995.26 / $3,019.95
| Professional | | $1,258.93 | $1,995.26 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,413.10 / $9,120.11
| Facility | | $4,073.80 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $616.60 / $1,659.59
| Professional | | $338.84 | $616.60 | $1,659.59 |