- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $6,025.60 / $16,982.44
| Facility | | $1,737.80 | $6,025.60 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $128.82 / $812.83
| Professional | | $95.50 | $128.82 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,570.88 / $12,882.50
| Facility | | $2,570.40 | $4,570.88 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $138.04 / $2,754.23
| Professional | | $63.10 | $138.04 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $1,380.38 / $2,691.53
| Facility | | $85.11 | $1,380.38 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $165.96 / $309.03
| Professional | | $87.10 | $165.96 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $467.74
| Facility | | $398.11 | $398.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $29.51 / $35.48
| Professional | | $28.18 | $29.51 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $426.58 / $3,388.44
| Professional | | $128.82 | $426.58 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $380.19 / $3,981.07
| Professional | | $114.82 | $380.19 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,715.35 / $3,715.35
| Facility | | $3,548.13 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $10,471.29 / $10,471.29
| Professional | | $10,471.29 | $10,471.29 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $3,467.37
| Facility | | $128.82 | $190.55 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $117.49 / $263.03
| Professional | | $112.20 | $117.49 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,884.03 / $7,943.28
| Facility | | $1,348.96 | $2,884.03 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $186.21 / $537.03
| Professional | | $123.03 | $186.21 | $537.03 |