- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,380.38 / $7,585.78
| Facility | | $331.13 | $1,380.38 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $741.31 / $1,318.26
| Professional | | $199.53 | $741.31 | $1,318.26 |
- 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
- $288.40 / $1,230.27 / $2,454.71
| Professional | | $288.40 | $1,230.27 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $758.58 / $1,230.27
| Facility | | $489.78 | $758.58 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $588.84 / $1,737.80
| Professional | | $239.88 | $588.84 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,584.89
| Professional | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $676.08 / $1,584.89
| Facility | | $199.53 | $676.08 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $2,290.87
| Professional | | $1,584.89 | $1,584.89 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,202.26 / $1,202.26
| Professional | | $1,122.02 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $2,398.83 / $6,165.95
| Facility | | $416.87 | $2,398.83 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $660.69 / $1,513.56
| Professional | | $199.53 | $660.69 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $3,715.35 / $3,715.35
| Facility | | $56.23 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $5,888.44 / $6,309.57
| Professional | | $5,888.44 | $5,888.44 | $6,309.57 |