- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $5,888.44 / $16,595.87
| Facility | | $1,737.80 | $5,888.44 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $380.19 / $1,737.80
| Professional | | $100.00 | $380.19 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,466.84 / $12,022.64
| Facility | | $2,570.40 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $416.87 / $1,047.13
| Professional | | $169.82 | $416.87 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $3,162.28 / $6,606.93
| Facility | | $85.11 | $3,162.28 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $457.09 / $1,230.27
| Professional | | $112.20 | $457.09 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $891.25 / $1,202.26
| Facility | | $630.96 | $891.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $389.05 / $1,380.38
| Professional | | $114.82 | $389.05 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $891.25 / $1,318.26
| Professional | | $104.71 | $891.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $707.95 / $1,412.54
| Professional | | $95.50 | $707.95 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $3,715.35
| Facility | | $54.95 | $56.23 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $5,370.32 / $5,370.32
| Professional | | $4,570.88 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $912.01
| Professional | | $32.36 | $33.11 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $338.84 / $1,258.93
| Facility | | $104.71 | $338.84 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $331.13 / $1,621.81
| Professional | | $114.82 | $331.13 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $2,137.96
| Professional | | $331.13 | $331.13 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $117.49 / $1,148.15
| Professional | | $85.11 | $117.49 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $4,073.80 / $9,549.93
| Facility | | $1,905.46 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $457.09 / $1,023.29
| Professional | | $91.20 | $457.09 | $1,023.29 |