- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $3,715.35 / $12,882.50
| Facility | | $870.96 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $691.83 / $1,071.52
| Professional | | $467.74 | $691.83 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $691.83 / $691.83
| Professional | | $645.65 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $208.93 / $954.99
| Facility | | $102.33 | $208.93 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $630.96 / $1,047.13
| Professional | | $446.68 | $630.96 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $630.96 / $630.96
| Facility | | $426.58 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $870.96 / $1,380.38
| Professional | | $524.81 | $870.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $3,019.95
| Facility | | $54.95 | $56.23 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,754.40 / $5,754.40
| Professional | | $5,011.87 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $851.14 / $1,995.26
| Facility | | $512.86 | $851.14 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $741.31 / $1,288.25
| Professional | | $489.78 | $741.31 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $389.05 / $588.84
| Professional | | $32.36 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Professional | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $812.83 / $1,380.38
| Facility | | $501.19 | $812.83 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $851.14 / $1,348.96
| Professional | | $524.81 | $851.14 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $870.96 / $2,238.72
| Facility | | $173.78 | $870.96 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $691.83 / $1,047.13
| Professional | | $478.63 | $691.83 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $707.95 / $724.44
| Professional | | $691.83 | $707.95 | $724.44 |