- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $2,691.53 / $5,623.41
| Facility | | $263.03 | $2,691.53 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $257.04 / $537.03
| Professional | | $131.83 | $257.04 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,584.89 / $4,786.30
| Facility | | $331.13 | $1,584.89 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $295.12 / $1,905.46
| Professional | | $138.04 | $295.12 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $371.54
| Facility | | $158.49 | $158.49 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $323.59 / $562.34
| Professional | | $158.49 | $323.59 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $416.87 / $741.31
| Facility | | $199.53 | $416.87 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $309.03 / $660.69
| Professional | | $154.88 | $309.03 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $3,311.31
| Facility | | $117.49 | $186.21 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $407.38 / $588.84
| Professional | | $288.40 | $407.38 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $3,162.28 / $8,511.38
| Facility | | $616.60 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $331.13 / $741.31
| Professional | | $158.49 | $331.13 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,584.89 / $4,786.30
| Facility | | $331.13 | $1,584.89 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $295.12 / $1,905.46
| Professional | | $138.04 | $295.12 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $2,884.03 / $8,128.31
| Facility | | $616.60 | $2,884.03 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $316.23 / $724.44
| Professional | | $147.91 | $316.23 | $724.44 |