- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,801.89 / $12,589.25
| Facility | | $776.25 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $354.81 / $1,584.89
| Professional | | $263.03 | $354.81 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,019.95 / $5,888.44
| Facility | | $2,344.23 | $3,019.95 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $489.78 / $707.95
| Professional | | $281.84 | $489.78 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $831.76 / $1,096.48
| Professional | | $380.19 | $831.76 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $524.81 / $2,454.71
| Facility | | $338.84 | $524.81 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $794.33 / $2,884.03
| Professional | | $457.09 | $794.33 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $891.25 / $1,122.02
| Professional | | $676.08 | $891.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $831.76
| Professional | | $630.96 | $630.96 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $588.84 / $1,023.29
| Professional | | $6.03 | $588.84 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,047.13 / $3,801.89
| Facility | | $380.19 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $602.56 / $891.25
| Professional | | $389.05 | $602.56 | $891.25 |