- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $2,187.76 / $5,495.41
| Facility | | $208.93 | $2,187.76 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $218.78 / $338.84
| Professional | | $181.97 | $218.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $724.44 / $794.33
| Professional | | $316.23 | $724.44 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $213.80 / $213.80
| Facility | | $186.21 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $630.96 / $1,318.26
| Professional | | $389.05 | $630.96 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,096.48 / $1,862.09
| Facility | | $407.38 | $1,096.48 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $407.38 / $812.83
| Professional | | $316.23 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $660.69 / $1,995.26
| Facility | | $575.44 | $660.69 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $398.11 / $794.33
| Professional | | $229.09 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $316.23
| Professional | | $263.03 | $263.03 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $346.74 / $758.58
| Professional | | $281.84 | $346.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,344.23 / $2,344.23
| Professional | | $1,659.59 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $288.40 / $478.63
| Facility | | $199.53 | $288.40 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $346.74 / $660.69
| Professional | | $186.21 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $446.68
| Professional | | $263.03 | $363.08 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $616.60 / $933.25
| Facility | | $213.80 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $275.42 / $676.08
| Professional | | $169.82 | $275.42 | $676.08 |