- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $7,943.28 / $14,454.40
| Facility | | $416.87 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $251.19 / $524.81
| Professional | | $213.80 | $251.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $12,589.25 / $24,547.09
| Facility | | $9,549.93 | $12,589.25 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $346.74 / $457.09
| Professional | | $204.17 | $346.74 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $501.19 / $758.58
| Professional | | $251.19 | $501.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $354.81 / $1,288.25
| Facility | | $213.80 | $354.81 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $457.09 / $4,365.16
| Professional | | $281.84 | $457.09 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $549.54 / $758.58
| Professional | | $436.52 | $549.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $457.09 / $758.58
| Professional | | $407.38 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $457.09 / $602.56
| Professional | | $288.40 | $457.09 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,466.84 / $8,128.31
| Facility | | $3,235.94 | $4,466.84 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $363.08 / $588.84
| Professional | | $275.42 | $363.08 | $588.84 |