- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,380.38 / $17,782.79
| Facility | | $489.78 | $1,380.38 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $416.87 / $1,148.15
| Professional | | $199.53 | $416.87 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,511.89 / $4,897.79
| Facility | | $1,862.09 | $2,511.89 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $660.69 / $1,122.02
| Professional | | $338.84 | $660.69 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $676.08 / $1,122.02
| Facility | | $630.96 | $676.08 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $537.03 / $1,230.27
| Professional | | $251.19 | $537.03 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $501.19 / $1,174.90
| Facility | | $239.88 | $501.19 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $501.19 / $1,122.02
| Professional | | $239.88 | $501.19 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $128.82
| Professional | | $32.36 | $33.11 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $891.25 / $1,071.52
| Facility | | $645.65 | $891.25 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $645.65 / $645.65
| Facility | | $616.60 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $616.60 / $1,122.02
| Professional | | $295.12 | $616.60 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,511.89 / $4,897.79
| Facility | | $1,905.46 | $2,511.89 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $660.69 / $1,122.02
| Professional | | $338.84 | $660.69 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $2,754.23 / $5,011.87
| Facility | | $812.83 | $2,754.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $512.86 / $1,148.15
| Professional | | $269.15 | $512.86 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $398.11 / $676.08
| Professional | | $208.93 | $398.11 | $676.08 |