- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,818.38 / $6,918.31
| Facility | | $707.95 | $2,818.38 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $117.49 / $218.78
| Professional | | $60.26 | $117.49 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $758.58 / $3,981.07
| Facility | | $363.08 | $758.58 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $112.20 / $190.55
| Professional | | $63.10 | $112.20 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $128.82
| Facility | | $56.23 | $56.23 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $125.89 / $208.93
| Professional | | $74.13 | $125.89 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $28,840.32 / $28,840.32
| Facility | | $1,995.26 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,584.89
| Professional | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $154.88 / $3,890.45
| Facility | | $61.66 | $154.88 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $123.03 / $263.03
| Professional | | $64.57 | $123.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $57.54
| Professional | | $32.36 | $33.11 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $117.49 / $199.53
| Facility | | $58.88 | $117.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $125.89 / $223.87
| Professional | | $74.13 | $125.89 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $954.99 / $2,290.87
| Facility | | $162.18 | $954.99 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $104.71 / $173.78
| Professional | | $61.66 | $104.71 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $134.90
| Professional | | $128.82 | $128.82 | $134.90 |