- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $2,089.30 / $6,760.83
| Facility | | $309.03 | $2,089.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $316.23 / $707.95
| Professional | | $177.83 | $316.23 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $6,025.60 / $9,549.93
| Facility | | $2,454.71 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $190.55
| Professional | | $158.49 | $158.49 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,258.93 / $57,543.99
| Facility | | $1,174.90 | $1,258.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $309.03 / $524.81
| Professional | | $190.55 | $309.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $524.81 / $575.44
| Professional | | $346.74 | $524.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $371.54 / $549.54
| Professional | | $229.09 | $371.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $954.99 / $2,398.83
| Facility | | $562.34 | $954.99 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $331.13 / $380.19
| Professional | | $223.87 | $331.13 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $4,466.84 / $8,317.64
| Facility | | $537.03 | $4,466.84 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $316.23
| Professional | | $158.49 | $158.49 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,288.25 / $6,165.95
| Facility | | $257.04 | $1,288.25 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $295.12 / $549.54
| Professional | | $181.97 | $295.12 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $537.03 / $1,230.27
| Professional | | $275.42 | $537.03 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $323.59 / $407.38
| Facility | | $186.21 | $323.59 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $323.59 / $407.38
| Professional | | $199.53 | $323.59 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $977.24 / $3,890.45
| Facility | | $363.08 | $977.24 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $489.78
| Professional | | $173.78 | $281.84 | $489.78 |