- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $954.99 / $5,888.44
| Facility | | $131.83 | $954.99 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $234.42 / $602.56
| Professional | | $131.83 | $234.42 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $741.31
| Professional | | $208.93 | $323.59 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $758.58 / $1,258.93
| Facility | | $645.65 | $758.58 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $549.54 / $1,096.48
| Professional | | $229.09 | $549.54 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $295.12 / $3,162.28
| Facility | | $141.25 | $295.12 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $426.58 / $660.69
| Professional | | $263.03 | $426.58 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $331.13 / $10,471.29
| Facility | | $141.25 | $331.13 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $616.60 / $2,754.23
| Professional | | $281.84 | $616.60 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $194.98
| Professional | | $32.36 | $33.11 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $8,511.38 / $9,120.11
| Facility | | $288.40 | $8,511.38 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $562.34 / $851.14
| Professional | | $295.12 | $562.34 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $467.74 / $831.76
| Professional | | $263.03 | $467.74 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $7,413.10 / $10,964.78
| Facility | | $3,981.07 | $7,413.10 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $1,621.81 / $2,884.03
| Professional | | $275.42 | $1,621.81 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $870.96
| Professional | | $501.19 | $501.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $870.96 / $1,412.54
| Professional | | $645.65 | $870.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $10,000.00 / $12,022.64
| Facility | | $6,309.57 | $10,000.00 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $338.84 / $891.25
| Professional | | $165.96 | $338.84 | $891.25 |