- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $2,187.76 / $3,801.89
| Facility | | $478.63 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $389.05 / $758.58
| Professional | | $123.03 | $389.05 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $3,981.07 / $19,498.45
| Facility | | $323.59 | $3,981.07 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $436.52 / $3,090.30
| Professional | | $138.04 | $436.52 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $354.81
| Facility | | $151.36 | $151.36 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $758.58 / $1,737.80
| Professional | | $251.19 | $758.58 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $501.19 / $3,090.30
| Facility | | $199.53 | $501.19 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $389.05 / $1,096.48
| Professional | | $154.88 | $389.05 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $177.83 / $3,311.31
| Facility | | $109.65 | $177.83 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $645.65 / $954.99
| Professional | | $457.09 | $645.65 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $3,801.89 / $9,772.37
| Facility | | $524.81 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $478.63 / $1,174.90
| Professional | | $144.54 | $478.63 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $3,981.07 / $19,498.45
| Facility | | $323.59 | $3,981.07 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $436.52 / $3,090.30
| Professional | | $138.04 | $436.52 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $3,548.13 / $9,120.11
| Facility | | $588.84 | $3,548.13 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $398.11 / $1,174.90
| Professional | | $144.54 | $398.11 | $1,174.90 |