- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $6,025.60 / $9,549.93
| Facility | | $1,047.13 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $204.17 / $457.09
| Professional | | $181.97 | $204.17 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $7,585.78 / $57,543.99
| Facility | | $6,456.54 | $7,585.78 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $346.74
| Professional | | $208.93 | $208.93 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $309.03 / $467.74
| Professional | | $199.53 | $309.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $302.00
| Professional | | $275.42 | $275.42 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $426.58
| Professional | | $190.55 | $288.40 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $4,786.30 / $8,709.64
| Facility | | $912.01 | $4,786.30 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $208.93 / $1,445.44
| Professional | | $181.97 | $208.93 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $338.84 / $446.68
| Professional | | $302.00 | $338.84 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $933.25
| Facility | | $199.53 | $199.53 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $302.00 / $933.25
| Professional | | $199.53 | $302.00 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,818.38 / $5,495.41
| Facility | | $1,000.00 | $2,818.38 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $436.52
| Professional | | $186.21 | $263.03 | $436.52 |