- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $478.63 / $1,905.46
| Facility | | $173.78 | $478.63 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $363.08 / $676.08
| Professional | | $154.88 | $363.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $537.03 / $1,659.59
| Professional | | $218.78 | $537.03 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,318.26 / $2,137.96
| Facility | | $1,148.15 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $588.84 / $1,584.89
| Professional | | $199.53 | $588.84 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $426.58 / $2,818.38
| Facility | | $158.49 | $426.58 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $575.44 / $1,148.15
| Professional | | $288.40 | $575.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $436.52 / $4,265.80
| Facility | | $162.18 | $436.52 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $870.96 / $3,090.30
| Professional | | $398.11 | $870.96 | $3,090.30 |
- 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
- $346.74 / $3,890.45 / $4,570.88
| Facility | | $346.74 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $660.69 / $1,258.93
| Professional | | $389.05 | $660.69 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $616.60 / $1,548.82
| Professional | | $257.04 | $616.60 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $4,897.79 / $4,897.79
| Facility | | $269.15 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $891.25 / $2,951.21
| Professional | | $213.80 | $891.25 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $1,621.81
| Professional | | $575.44 | $575.44 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $870.96 / $2,137.96
| Professional | | $575.44 | $870.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,548.13 / $6,760.83
| Facility | | $2,754.23 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $446.68 / $1,202.26
| Professional | | $177.83 | $446.68 | $1,202.26 |