- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $575.44 / $3,090.30
| Facility | | $288.40 | $575.44 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $1,071.52
| Professional | | $288.40 | $436.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $794.33 / $1,949.84
| Professional | | $389.05 | $794.33 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,348.96 / $2,137.96
| Facility | | $1,148.15 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $891.25 / $1,513.56
| Professional | | $389.05 | $891.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $851.14 / $4,265.80
| Facility | | $281.84 | $851.14 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $831.76 / $1,230.27
| Professional | | $602.56 | $831.76 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $2,570.40 / $6,309.57
| Facility | | $281.84 | $2,570.40 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $724.44 / $2,238.72
| Professional | | $389.05 | $724.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $501.19
| Professional | | $32.36 | $33.11 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $3,890.45 / $4,570.88
| Facility | | $562.34 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $933.25 / $1,479.11
| Professional | | $602.56 | $933.25 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $831.76 / $1,445.44
| Professional | | $467.74 | $831.76 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $9,332.54 / $9,332.54
| Facility | | $6,309.57 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,230.27 / $3,019.95
| Professional | | $407.38 | $1,230.27 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $2,290.87
| Professional | | $1,445.44 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,949.84 / $2,630.27
| Professional | | $1,258.93 | $1,949.84 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,630.78 / $7,244.36
| Facility | | $2,884.03 | $3,630.78 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $588.84 / $1,548.82
| Professional | | $331.13 | $588.84 | $1,548.82 |