- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $5,495.41 / $12,882.50
| Facility | | $316.23 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $389.05 / $776.25
| Professional | | $229.09 | $389.05 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Professional | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $4,265.80 / $12,302.69
| Facility | | $257.04 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $295.12 / $630.96
| Professional | | $234.42 | $295.12 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $12,589.25 / $53,703.18
| Facility | | $165.96 | $12,589.25 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $416.87 / $977.24
| Professional | | $213.80 | $416.87 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,090.30 / $6,309.57
| Facility | | $2,089.30 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $645.65
| Professional | | $204.17 | $281.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $338.84
| Professional | | $32.36 | $33.11 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $2,238.72 / $5,011.87
| Facility | | $457.09 | $2,238.72 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $426.58 / $758.58
| Professional | | $223.87 | $426.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $223.87 / $309.03
| Professional | | $208.93 | $223.87 | $309.03 |