- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $2,398.83 / $8,317.64
| Facility | | $229.09 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $407.38
| Professional | | $134.90 | $204.17 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Professional | | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $112.20
| Professional | | $107.15 | $107.15 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,691.53 / $57,543.99
| Facility | | $2,630.27 | $2,691.53 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $380.19 / $380.19
| Professional | | $363.08 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $229.09 / $371.54
| Professional | | $165.96 | $229.09 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $354.81 / $389.05
| Professional | | $234.42 | $354.81 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $269.15 / $380.19
| Professional | | $194.98 | $269.15 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $3,890.45 / $7,413.10
| Facility | | $1,071.52 | $3,890.45 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $229.09 / $288.40
| Professional | | $194.98 | $229.09 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Professional | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $1,584.89 / $6,165.95
| Facility | | $208.93 | $1,584.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $213.80 / $416.87
| Professional | | $158.49 | $213.80 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $380.19 / $891.25
| Professional | | $257.04 | $380.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $467.74
| Facility | | $162.18 | $223.87 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $467.74
| Professional | | $162.18 | $223.87 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $2,570.40 / $5,495.41
| Facility | | $549.54 | $2,570.40 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $218.78 / $380.19
| Professional | | $151.36 | $218.78 | $380.19 |