- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,412.54 / $3,630.78
| Facility | | $141.25 | $1,412.54 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $213.80 / $501.19
| Professional | | $89.13 | $213.80 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,348.96 / $3,801.89
| Facility | | $56.23 | $1,348.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $239.88 / $758.58
| Professional | | $107.15 | $239.88 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $295.12
| Facility | | $125.89 | $125.89 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $288.40 / $562.34
| Professional | | $125.89 | $288.40 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $257.04 / $602.56
| Professional | | $125.89 | $257.04 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $3,630.78
| Facility | | $109.65 | $154.88 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $371.54 / $478.63
| Professional | | $309.03 | $371.54 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,511.89 / $7,079.46
| Facility | | $1,288.25 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $275.42 / $676.08
| Professional | | $128.82 | $275.42 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $309.03 / $575.44
| Facility | | $165.96 | $309.03 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,348.96 / $3,801.89
| Facility | | $56.23 | $1,348.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $239.88 / $758.58
| Professional | | $107.15 | $239.88 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,089.30 / $5,623.41
| Facility | | $954.99 | $2,089.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $239.88 / $630.96
| Professional | | $109.65 | $239.88 | $630.96 |