- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,801.89 / $8,511.38
| Facility | | $2,344.23 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $489.78 / $1,148.15
| Professional | | $194.98 | $489.78 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $676.08
| Professional | | $194.98 | $194.98 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,466.84 / $8,709.64
| Facility | | $3,388.44 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $389.05 / $588.84
| Professional | | $239.88 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $616.60 / $912.01
| Professional | | $407.38 | $616.60 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $478.63 / $1,778.28
| Facility | | $275.42 | $478.63 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $630.96 / $2,290.87
| Professional | | $331.13 | $630.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $645.65 / $891.25
| Professional | | $467.74 | $645.65 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $645.65 / $691.83
| Professional | | $467.74 | $645.65 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,548.82 / $5,248.07
| Facility | | $870.96 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $467.74 / $724.44
| Professional | | $269.15 | $467.74 | $724.44 |