- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,884.03 / $5,248.07
| Facility | | $1,513.56 | $2,884.03 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $758.58 / $2,137.96
| Professional | | $199.53 | $758.58 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,818.38 / $9,772.37
| Facility | | $56.23 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $977.24 / $3,311.31
| Professional | | $208.93 | $977.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $524.81
| Facility | | $223.87 | $223.87 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,174.90 / $2,511.89
| Professional | | $281.84 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $741.31 / $3,715.35
| Facility | | $676.08 | $741.31 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $794.33 / $2,951.21
| Professional | | $239.88 | $794.33 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $239.88 / $3,311.31
| Facility | | $154.88 | $239.88 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,318.26 / $2,137.96
| Professional | | $933.25 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $4,570.88 / $11,220.18
| Facility | | $645.65 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $954.99 / $2,398.83
| Professional | | $208.93 | $954.99 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,818.38 / $7,413.10
| Facility | | $1,819.70 | $2,818.38 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,818.38 / $9,772.37
| Facility | | $56.23 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $977.24 / $3,311.31
| Professional | | $208.93 | $977.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $4,265.80 / $9,549.93
| Facility | | $1,479.11 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $977.24 / $2,630.27
| Professional | | $223.87 | $977.24 | $2,630.27 |