- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,454.71 / $7,585.78
| Facility | | $575.44 | $2,454.71 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $1,122.02 / $1,737.80
| Professional | | $245.47 | $1,122.02 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $1,047.13
| Professional | | $213.80 | $213.80 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $4,365.16 / $14,125.38
| Facility | | $1,096.48 | $4,365.16 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $954.99 / $1,584.89
| Professional | | $218.78 | $954.99 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $575.44 / $2,398.83
| Professional | | $275.42 | $575.44 | $2,398.83 |
- 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
- $9,772.37 / $9,772.37 / $11,481.54
| Professional | | $9,772.37 | $9,772.37 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,548.82 / $4,677.35
| Facility | | $295.12 | $1,548.82 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,230.27 / $2,187.76
| Professional | | $263.03 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $190.55
| Professional | | $32.36 | $33.11 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $851.14 / $4,168.69
| Professional | | $213.80 | $851.14 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,148.15 / $2,884.03
| Facility | | $257.04 | $1,148.15 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $575.44 / $2,398.83
| Professional | | $269.15 | $575.44 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $954.99 / $2,290.87
| Facility | | $162.18 | $954.99 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $977.24 / $2,290.87
| Professional | | $223.87 | $977.24 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,174.90
| Professional | | $1,096.48 | $1,096.48 | $1,174.90 |