- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,659.59 / $4,168.69
| Facility | | $954.99 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $707.95 / $1,479.11
| Professional | | $457.09 | $707.95 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,122.02 / $1,513.56
| Facility | | $758.58 | $1,122.02 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $724.44 / $1,000.00
| Professional | | $575.44 | $724.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,621.81 / $1,995.26
| Facility | | $645.65 | $1,621.81 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $794.33 / $1,071.52
| Professional | | $380.19 | $794.33 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $831.76 / $2,344.23
| Facility | | $125.89 | $831.76 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $870.96 / $2,041.74
| Professional | | $125.89 | $870.96 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $602.56 / $812.83
| Professional | | $75.86 | $602.56 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $1,513.56
| Facility | | $758.58 | $758.58 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $831.76
| Professional | | $758.58 | $758.58 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,202.26 / $2,344.23
| Facility | | $758.58 | $1,202.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $954.99
| Professional | | $676.08 | $676.08 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,148.15 / $1,995.26
| Facility | | $870.96 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $758.58 / $1,288.25
| Professional | | $575.44 | $758.58 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $912.01 / $912.01
| Facility | | $676.08 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $316.23 / $851.14
| Professional | | $38.02 | $316.23 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $389.05 / $1,380.38
| Professional | | $338.84 | $389.05 | $1,380.38 |