- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $3,801.89 / $12,589.25
| Facility | | $457.09 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $281.84 / $977.24
| Professional | | $162.18 | $281.84 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $6,456.54 / $12,589.25
| Facility | | $5,011.87 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $295.12 / $407.38
| Professional | | $173.78 | $295.12 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $416.87 / $602.56
| Professional | | $208.93 | $416.87 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $316.23 / $1,318.26
| Facility | | $190.55 | $316.23 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $1,584.89
| Professional | | $245.47 | $436.52 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $478.63 / $602.56
| Professional | | $389.05 | $478.63 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $467.74 / $645.65
| Professional | | $346.74 | $467.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,548.82 / $5,248.07
| Facility | | $1,096.48 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $354.81 / $524.81
| Professional | | $208.93 | $354.81 | $524.81 |