- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $6,025.60 / $16,982.44
| Facility | | $1,659.59 | $6,025.60 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $257.04 / $1,071.52
| Professional | | $120.23 | $257.04 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $123.03
| Professional | | $117.49 | $117.49 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $10,471.29 / $17,782.79
| Facility | | $6,025.60 | $10,471.29 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,122.02 / $2,398.83
| Professional | | $194.98 | $1,122.02 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $6,918.31 / $12,882.50
| Facility | | $79.43 | $6,918.31 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $549.54 / $1,737.80
| Professional | | $128.82 | $549.54 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $501.19 / $1,380.38
| Professional | | $138.04 | $501.19 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $660.69 / $954.99
| Professional | | $134.90 | $660.69 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $562.34 / $1,122.02
| Professional | | $125.89 | $562.34 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $6,760.83
| Facility | | $54.95 | $56.23 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $4,786.30 / $4,786.30
| Professional | | $3,981.07 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $794.33
| Professional | | $478.63 | $478.63 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $616.60 / $1,122.02
| Facility | | $151.36 | $616.60 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $478.63 / $1,445.44
| Professional | | $134.90 | $478.63 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $2,344.23
| Professional | | $467.74 | $467.74 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $660.69 / $1,122.02
| Professional | | $123.03 | $660.69 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,584.89 / $6,760.83
| Facility | | $575.44 | $1,584.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $562.34 / $1,412.54
| Professional | | $131.83 | $562.34 | $1,412.54 |