- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $3,090.30 / $5,128.61
| Facility | | $416.87 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $776.25
| Professional | | $251.19 | $416.87 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $3,235.94 / $45,708.82
| Facility | | $645.65 | $3,235.94 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $524.81 / $1,412.54
| Professional | | $309.03 | $524.81 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $758.58
| Facility | | $331.13 | $331.13 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $562.34 / $954.99
| Professional | | $331.13 | $562.34 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $524.81 / $1,047.13
| Professional | | $288.40 | $524.81 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $3,630.78
| Facility | | $269.15 | $389.05 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $588.84 / $794.33
| Professional | | $478.63 | $588.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,265.80 / $9,772.37
| Facility | | $2,041.74 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $549.54 / $1,096.48
| Professional | | $316.23 | $549.54 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $416.87 / $602.56
| Professional | | $309.03 | $416.87 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $3,235.94 / $45,708.82
| Facility | | $645.65 | $3,235.94 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $524.81 / $1,412.54
| Professional | | $309.03 | $524.81 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,890.45 / $8,709.64
| Facility | | $1,862.09 | $3,890.45 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $549.54 / $1,122.02
| Professional | | $316.23 | $549.54 | $1,122.02 |