- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $426.58 / $1,905.46
| Facility | | $194.98 | $426.58 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $234.42 / $512.86
| Professional | | $181.97 | $234.42 | $512.86 |
- 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
- $218.78 / $389.05 / $954.99
| Professional | | $218.78 | $389.05 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $758.58 / $1,202.26
| Facility | | $645.65 | $758.58 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $588.84 / $1,148.15
| Professional | | $245.47 | $588.84 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $316.23 / $3,162.28
| Facility | | $194.98 | $316.23 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $512.86 / $660.69
| Professional | | $380.19 | $512.86 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $338.84 / $1,584.89
| Facility | | $194.98 | $338.84 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $446.68 / $1,819.70
| Professional | | $199.53 | $446.68 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $186.21
| Professional | | $32.36 | $33.11 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $891.25 / $2,344.23
| Facility | | $288.40 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $891.25
| Professional | | $302.00 | $436.52 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $616.60 / $891.25
| Professional | | $371.54 | $616.60 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $537.03 / $1,288.25
| Facility | | $263.03 | $537.03 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,096.48 / $1,778.28
| Professional | | $363.08 | $1,096.48 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $776.25
| Professional | | $645.65 | $645.65 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,288.25 / $1,548.82
| Professional | | $537.03 | $1,288.25 | $1,548.82 |
- 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
- $177.83 / $302.00 / $831.76
| Professional | | $177.83 | $302.00 | $831.76 |