- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $3,235.94 / $8,317.64
| Facility | | $489.78 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $446.68 / $758.58
| Professional | | $380.19 | $446.68 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $524.81 / $812.83
| Professional | | $389.05 | $524.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $467.74 / $1,737.80
| Professional | | $407.38 | $467.74 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $125.89 / $162.18
| Facility | | $51.29 | $125.89 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $478.63 / $758.58
| Professional | | $354.81 | $478.63 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $426.58 / $724.44
| Professional | | $354.81 | $426.58 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $537.03 / $724.44
| Professional | | $501.19 | $537.03 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $524.81 / $812.83
| Facility | | $371.54 | $524.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $794.33
| Professional | | $263.03 | $263.03 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $489.78 / $1,174.90
| Facility | | $389.05 | $489.78 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $489.78 / $1,174.90
| Professional | | $389.05 | $489.78 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $812.83 / $2,344.23
| Facility | | $151.36 | $812.83 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $467.74 / $794.33
| Professional | | $323.59 | $467.74 | $794.33 |