- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,019.95 / $7,413.10
| Facility | | $707.95 | $3,019.95 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $288.40 / $436.52
| Professional | | $194.98 | $288.40 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $316.23
| Professional | | $275.42 | $275.42 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $758.58 / $1,621.81
| Facility | | $446.68 | $758.58 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $457.09
| Professional | | $186.21 | $281.84 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $575.44
| Professional | | $218.78 | $338.84 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $28,840.32 / $28,840.32
| Facility | | $1,995.26 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,454.71 / $2,454.71
| Professional | | $2,137.96 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $407.38 / $3,715.35
| Facility | | $213.80 | $407.38 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $323.59 / $575.44
| Professional | | $204.17 | $323.59 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $165.96
| Professional | | $32.36 | $33.11 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $660.69 / $776.25
| Professional | | $5.01 | $660.69 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $323.59 / $602.56
| Facility | | $199.53 | $323.59 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $346.74 / $575.44
| Professional | | $218.78 | $346.74 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $891.25 / $2,238.72
| Facility | | $173.78 | $891.25 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $288.40 / $467.74
| Professional | | $194.98 | $288.40 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $309.03 / $309.03
| Professional | | $295.12 | $309.03 | $309.03 |