- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $5,011.87 / $12,589.25
| Facility | | $426.58 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $234.42 / $724.44
| Professional | | $123.03 | $234.42 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $691.83 / $1,348.96
| Facility | | $524.81 | $691.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $239.88 / $389.05
| Professional | | $151.36 | $239.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $389.05 / $602.56
| Professional | | $199.53 | $389.05 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $288.40 / $1,230.27
| Facility | | $158.49 | $288.40 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $426.58 / $1,659.59
| Professional | | $275.42 | $426.58 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $457.09 / $602.56
| Professional | | $295.12 | $457.09 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $457.09
| Professional | | $295.12 | $295.12 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $263.03 / $562.34
| Professional | | $6.03 | $263.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $1,047.13 / $3,801.89
| Facility | | $245.47 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $295.12 / $501.19
| Professional | | $173.78 | $295.12 | $501.19 |