- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $2,570.40 / $4,570.88
| Facility | | $426.58 | $2,570.40 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,071.52 / $1,380.38
| Professional | | $346.74 | $1,071.52 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $323.59 / $426.58
| Professional | | $263.03 | $323.59 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,258.93 / $1,380.38
| Professional | | $912.01 | $1,258.93 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $616.60 / $6,165.95
| Facility | | $501.19 | $616.60 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $1,737.80
| Professional | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $446.68 / $549.54
| Professional | | $371.54 | $446.68 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,202.26 / $1,995.26
| Facility | | $549.54 | $1,202.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Professional | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $346.74 / $724.44
| Facility | | $128.82 | $346.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $407.38 / $870.96
| Professional | | $134.90 | $407.38 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $398.11 / $2,137.96
| Facility | | $144.54 | $398.11 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $457.09 / $794.33
| Professional | | $309.03 | $457.09 | $794.33 |