- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $398.11 / $758.58
| Professional | | $239.88 | $398.11 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,584.89 / $4,265.80
| Facility | | $407.38 | $1,584.89 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $537.03 / $741.31
| Professional | | $446.68 | $537.03 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Facility | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $407.38 / $602.56
| Professional | | $288.40 | $407.38 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $467.74 / $891.25
| Facility | | $263.03 | $467.74 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $549.54 / $794.33
| Professional | | $389.05 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,630.78 / $5,248.07
| Facility | | $2,754.23 | $3,630.78 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $549.54 / $776.25
| Professional | | $446.68 | $549.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $1,995.26
| Professional | | $302.00 | $436.52 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $3,388.44 / $4,466.84
| Facility | | $446.68 | $3,388.44 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $426.58 / $660.69
| Professional | | $281.84 | $426.58 | $660.69 |