- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,659.59 / $8,128.31
| Facility | | $416.87 | $1,659.59 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $323.59 / $616.60
| Professional | | $275.42 | $323.59 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $457.09 / $933.25
| Professional | | $275.42 | $457.09 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $36,307.81
| Facility | | $398.11 | $398.11 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $426.58 / $741.31
| Professional | | $316.23 | $426.58 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $724.44
| Professional | | $501.19 | $501.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $407.38 / $645.65
| Facility | | $309.03 | $407.38 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $562.34 / $660.69
| Professional | | $457.09 | $562.34 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $21,379.62 / $30,902.95
| Facility | | $9,549.93 | $21,379.62 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $354.81 / $602.56
| Professional | | $257.04 | $354.81 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19,498.45 / $85,113.80 / $85,113.80
| Facility | | $19,498.45 | $85,113.80 | $85,113.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $8,317.64 / $8,317.64
| Professional | | $2,754.23 | $8,317.64 | $8,317.64 |