- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $4,786.30 / $8,709.64
| Facility | | $389.05 | $4,786.30 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $1,047.13
| Professional | | $263.03 | $363.08 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,819.70 / $2,041.74
| Facility | | $1,548.82 | $1,819.70 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $407.38 / $741.31
| Professional | | $309.03 | $407.38 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $3,388.44 / $5,623.41
| Facility | | $489.78 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $380.19 / $645.65
| Professional | | $269.15 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Professional | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $338.84 / $537.03
| Facility | | $251.19 | $338.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $676.08
| Professional | | $316.23 | $316.23 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $331.13 / $331.13
| Professional | | $316.23 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $4,897.79 / $10,232.93
| Facility | | $954.99 | $4,897.79 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $288.40 / $524.81
| Professional | | $218.78 | $288.40 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16,982.44 / $16,982.44 / $33,884.42
| Facility | | $16,982.44 | $16,982.44 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $2,290.87
| Professional | | $1,995.26 | $1,995.26 | $2,290.87 |