- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $2,187.76 / $6,918.31
| Facility | | $204.17 | $2,187.76 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $112.20 / $204.17
| Professional | | $38.02 | $112.20 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $77.62
| Professional | | $30.20 | $36.31 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $630.96
| Facility | | $83.18 | $141.25 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $81.28 / $158.49
| Professional | | $31.62 | $81.28 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $257.04 / $257.04
| Facility | | $30.20 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $112.20 / $208.93
| Professional | | $41.69 | $112.20 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $512.86
| Facility | | $54.95 | $56.23 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $977.24 / $977.24
| Professional | | $831.76 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $134.90 / $1,445.44
| Facility | | $39.81 | $134.90 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $117.49 / $245.47
| Professional | | $38.90 | $117.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $102.33
| Professional | | $29.51 | $33.11 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $229.09 / $331.13
| Professional | | $173.78 | $229.09 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $117.49 / $234.42
| Facility | | $38.90 | $117.49 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $109.65 / $229.09
| Professional | | $41.69 | $109.65 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $812.83 / $2,951.21
| Facility | | $154.88 | $812.83 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $104.71 / $186.21
| Professional | | $37.15 | $104.71 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $117.49 / $138.04
| Professional | | $109.65 | $117.49 | $138.04 |