- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $2,089.30 / $3,715.35
| Facility | | $288.40 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $389.05 / $1,122.02
| Professional | | $162.18 | $389.05 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $954.99 / $2,818.38
| Facility | | $56.23 | $954.99 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $426.58 / $1,174.90
| Professional | | $186.21 | $426.58 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $467.74
| Facility | | $199.53 | $199.53 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $478.63 / $1,096.48
| Professional | | $257.04 | $478.63 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $416.87 / $933.25
| Professional | | $194.98 | $416.87 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $199.53 / $3,630.78
| Facility | | $144.54 | $199.53 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $524.81 / $676.08
| Professional | | $446.68 | $524.81 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $398.11 / $954.99
| Professional | | $169.82 | $398.11 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $645.65 / $1,258.93
| Professional | | $602.56 | $645.65 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $954.99 / $2,818.38
| Facility | | $56.23 | $954.99 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $426.58 / $1,174.90
| Professional | | $186.21 | $426.58 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $812.83
| Professional | | $302.00 | $426.58 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,862.09 / $2,818.38
| Facility | | $524.81 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $389.05 / $912.01
| Professional | | $181.97 | $389.05 | $912.01 |