- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $3,019.95 / $7,762.47
| Facility | | $269.15 | $3,019.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $323.59 / $812.83
| Professional | | $165.96 | $323.59 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,897.79 / $14,454.40
| Facility | | $2,630.27 | $4,897.79 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $331.13 / $812.83
| Professional | | $263.03 | $331.13 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,258.93 / $4,073.80
| Facility | | $213.80 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $512.86
| Professional | | $213.80 | $213.80 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,819.70 / $53,703.18
| Facility | | $257.04 | $1,819.70 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | 53 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $426.58 / $1,096.48
| Professional | | $194.98 | $426.58 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $213.80 / $524.81
| Facility | | $158.49 | $213.80 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $724.44
| Professional | | $346.74 | $512.86 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $436.52 / $758.58
| Professional | | $251.19 | $436.52 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $4,365.16 / $7,943.28
| Facility | | $1,445.44 | $4,365.16 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $50,118.72 / $75,857.76
| Facility | | $199.53 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $426.58 / $724.44
| Professional | | $380.19 | $426.58 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $4,168.69 / $10,471.29
| Facility | | $2,137.96 | $4,168.69 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $389.05 / $831.76
| Professional | | $165.96 | $389.05 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $173.78 / $676.08
| Facility | | $123.03 | $173.78 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $407.38 / $758.58
| Professional | | $251.19 | $407.38 | $758.58 |