- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,951.21 / $7,413.10
| Facility | | $707.95 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $467.74 / $741.31
| Professional | | $389.05 | $467.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,187.76 / $4,265.80
| Facility | | $1,122.02 | $2,187.76 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $512.86 / $741.31
| Professional | | $407.38 | $512.86 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $407.38 / $407.38
| Facility | | $79.43 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $575.44 / $912.01
| Professional | | $416.87 | $575.44 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $28,840.32 / $28,840.32
| Facility | | $4,897.79 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,073.80 / $4,073.80
| Professional | | $3,467.37 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $602.56 / $2,754.23
| Facility | | $416.87 | $602.56 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $954.99
| Professional | | $407.38 | $602.56 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $398.11
| Professional | | $32.36 | $33.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $549.54 / $933.25
| Facility | | $407.38 | $549.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $575.44 / $891.25
| Professional | | $416.87 | $575.44 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $1,047.13 / $2,454.71
| Facility | | $173.78 | $1,047.13 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $457.09 / $707.95
| Professional | | $346.74 | $457.09 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $512.86 / $524.81
| Professional | | $489.78 | $512.86 | $524.81 |