- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $2,187.76 / $6,606.93
| Facility | | $234.42 | $2,187.76 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $309.03 / $660.69
| Professional | | $169.82 | $309.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Professional | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,778.28 / $1,995.26
| Facility | | $1,513.56 | $1,778.28 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $331.13 / $724.44
| Professional | | $173.78 | $331.13 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,348.96 / $2,691.53
| Facility | | $323.59 | $1,348.96 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $323.59 / $602.56
| Professional | | $190.55 | $323.59 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $295.12 / $489.78
| Facility | | $169.82 | $295.12 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $758.58
| Professional | | $190.55 | $190.55 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $281.84 / $489.78
| Professional | | $245.47 | $281.84 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $2,570.40 / $6,165.95
| Facility | | $416.87 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $251.19 / $457.09
| Professional | | $158.49 | $251.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $8,128.31 / $19,498.45
| Facility | | $8,128.31 | $8,128.31 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,630.27
| Professional | | $2,238.72 | $2,238.72 | $2,630.27 |