- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $269.15 / $3,090.30
| Facility | | $123.03 | $269.15 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $199.53 / $446.68
| Professional | | $120.23 | $199.53 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $363.08 / $851.14
| Professional | | $199.53 | $363.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $676.08 / $1,071.52
| Facility | | $575.44 | $676.08 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $389.05 / $724.44
| Professional | | $165.96 | $389.05 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $436.52 / $5,754.40
| Facility | | $123.03 | $436.52 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $380.19 / $616.60
| Professional | | $281.84 | $380.19 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $2,570.40 / $5,754.40
| Facility | | $131.83 | $2,570.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $363.08 / $1,096.48
| Professional | | $208.93 | $363.08 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $288.40
| Professional | | $32.36 | $33.11 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $3,890.45 / $4,570.88
| Facility | | $263.03 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $489.78 / $676.08
| Professional | | $295.12 | $489.78 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $407.38 / $707.95
| Professional | | $234.42 | $407.38 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $4,786.30 / $4,786.30
| Facility | | $602.56 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $575.44 / $1,479.11
| Professional | | $177.83 | $575.44 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $602.56
| Professional | | $363.08 | $363.08 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $741.31 / $1,202.26
| Professional | | $389.05 | $741.31 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,548.13 / $6,606.93
| Facility | | $2,884.03 | $3,548.13 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $288.40 / $724.44
| Professional | | $141.25 | $288.40 | $724.44 |