- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $2,238.72 / $3,801.89
| Facility | | $257.04 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $257.04 / $512.86
| Professional | | $173.78 | $257.04 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,023.29 / $19,498.45
| Facility | | $309.03 | $1,023.29 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $323.59 / $1,949.84
| Professional | | $186.21 | $323.59 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $489.78
| Facility | | $213.80 | $213.80 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $363.08 / $363.08
| Professional | | $204.17 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $478.63 / $602.56
| Facility | | $446.68 | $478.63 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $338.84 / $660.69
| Professional | | $194.98 | $338.84 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $239.88 / $3,311.31
| Facility | | $154.88 | $239.88 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $354.81 / $524.81
| Professional | | $251.19 | $354.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,819.70 / $3,467.37
| Facility | | $229.09 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $338.84 / $660.69
| Professional | | $194.98 | $338.84 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,023.29 / $19,498.45
| Facility | | $309.03 | $1,023.29 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $323.59 / $1,949.84
| Professional | | $186.21 | $323.59 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $1,122.02 / $2,754.23
| Facility | | $288.40 | $1,122.02 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $346.74 / $691.83
| Professional | | $190.55 | $346.74 | $691.83 |