- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $3,235.94 / $8,317.64
| Facility | | $489.78 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $489.78 / $794.33
| Professional | | $407.38 | $489.78 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $758.58
| Professional | | $407.38 | $537.03 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $691.83 / $954.99
| Professional | | $457.09 | $691.83 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $537.03 / $870.96
| Professional | | $398.11 | $537.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $457.09 / $1,174.90
| Professional | | $380.19 | $457.09 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $660.69 / $977.24
| Professional | | $524.81 | $660.69 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $602.56 / $891.25
| Facility | | $426.58 | $602.56 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $562.34 / $8,709.64
| Facility | | $380.19 | $562.34 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $562.34 / $8,709.64
| Professional | | $380.19 | $562.34 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,025.60 / $12,882.50
| Facility | | $3,630.78 | $6,025.60 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $524.81 / $870.96
| Professional | | $363.08 | $524.81 | $870.96 |