- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $954.99 / $4,570.88
| Facility | | $309.03 | $954.99 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $446.68 / $977.24
| Professional | | $295.12 | $446.68 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $7,762.47 / $13,182.57
| Facility | | $3,981.07 | $7,762.47 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $645.65 / $1,479.11
| Professional | | $426.58 | $645.65 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,479.11 / $2,344.23
| Facility | | $1,258.93 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $977.24 / $1,584.89
| Professional | | $416.87 | $977.24 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $954.99 / $3,801.89
| Facility | | $363.08 | $954.99 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $977.24 / $1,380.38
| Professional | | $707.95 | $977.24 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $2,570.40 / $6,309.57
| Facility | | $380.19 | $2,570.40 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $794.33 / $2,454.71
| Professional | | $457.09 | $794.33 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $616.60
| Professional | | $32.36 | $33.11 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $3,890.45 / $4,570.88
| Facility | | $660.69 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,047.13 / $1,445.44
| Professional | | $660.69 | $1,047.13 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,000.00 / $1,584.89
| Professional | | $524.81 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $6,760.83 / $6,760.83
| Facility | | $4,570.88 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,288.25 / $3,388.44
| Professional | | $446.68 | $1,288.25 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $1,318.26
| Professional | | $912.01 | $912.01 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,862.09 / $2,691.53
| Professional | | $1,023.29 | $1,862.09 | $2,691.53 |
- 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
- $363.08 / $660.69 / $1,659.59
| Professional | | $363.08 | $660.69 | $1,659.59 |