- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $407.38 / $1,905.46
| Facility | | $223.87 | $407.38 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $288.40 / $524.81
| Professional | | $181.97 | $288.40 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,786.30 / $7,585.78
| Facility | | $3,311.31 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $489.78 / $1,318.26
| Professional | | $251.19 | $489.78 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $977.24 / $1,548.82
| Facility | | $831.76 | $977.24 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $512.86 / $1,318.26
| Professional | | $213.80 | $512.86 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $302.00 / $2,754.23
| Facility | | $177.83 | $302.00 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $549.54 / $812.83
| Professional | | $363.08 | $549.54 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $309.03 / $3,801.89
| Facility | | $177.83 | $309.03 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $630.96 / $2,290.87
| Professional | | $245.47 | $630.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $229.09
| Professional | | $32.36 | $33.11 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $3,890.45 / $4,570.88
| Facility | | $354.81 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $537.03 / $851.14
| Professional | | $338.84 | $537.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $602.56 / $1,047.13
| Professional | | $331.13 | $602.56 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $2,137.96 / $2,137.96
| Facility | | $316.23 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $660.69 / $2,187.76
| Professional | | $223.87 | $660.69 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $1,174.90
| Professional | | $741.31 | $741.31 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,000.00 / $1,584.89
| Professional | | $616.60 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,548.13 / $6,606.93
| Facility | | $2,884.03 | $3,548.13 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $338.84 / $977.24
| Professional | | $186.21 | $338.84 | $977.24 |