- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $5,011.87 / $12,589.25
| Facility | | $478.63 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $269.15 / $977.24
| Professional | | $165.96 | $269.15 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,365.16 / $8,511.38
| Facility | | $3,388.44 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $302.00 / $416.87
| Professional | | $169.82 | $302.00 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $407.38 / $575.44
| Professional | | $213.80 | $407.38 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $295.12 / $1,202.26
| Facility | | $177.83 | $295.12 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $380.19 / $1,621.81
| Professional | | $223.87 | $380.19 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $457.09 / $575.44
| Professional | | $363.08 | $457.09 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $489.78 / $660.69
| Professional | | $331.13 | $489.78 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,047.13 / $3,801.89
| Facility | | $676.08 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $295.12 / $489.78
| Professional | | $186.21 | $295.12 | $489.78 |