- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $257.04 / $1,905.46
| Facility | | $102.33 | $257.04 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $190.55 / $707.95
| Professional | | $107.15 | $190.55 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $346.74 / $758.58
| Professional | | $186.21 | $346.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $602.56 / $977.24
| Facility | | $524.81 | $602.56 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $281.84 / $549.54
| Professional | | $131.83 | $281.84 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $338.84 / $3,388.44
| Facility | | $120.23 | $338.84 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $354.81 / $575.44
| Professional | | $229.09 | $354.81 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $338.84 / $1,659.59
| Facility | | $123.03 | $338.84 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $331.13 / $912.01
| Professional | | $181.97 | $331.13 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $380.19
| Professional | | $32.36 | $33.11 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $891.25 / $2,344.23
| Facility | | $257.04 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $426.58 / $549.54
| Professional | | $213.80 | $426.58 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $363.08 / $616.60
| Professional | | $199.53 | $363.08 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,288.25 / $1,288.25
| Facility | | $316.23 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $257.04 / $1,412.54
| Professional | | $131.83 | $257.04 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $363.08
| Professional | | $223.87 | $223.87 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $524.81 / $831.76
| Professional | | $281.84 | $524.81 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,584.89 / $2,187.76
| Facility | | $977.24 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $190.55 / $776.25
| Professional | | $91.20 | $190.55 | $776.25 |