- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $4,073.80 / $8,912.51
| Facility | | $812.83 | $4,073.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $186.21 / $389.05
| Professional | | $131.83 | $186.21 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $223.87
| Professional | | $61.66 | $131.83 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $3,019.95 / $11,220.18
| Facility | | $870.96 | $3,019.95 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $144.54 / $245.47
| Professional | | $107.15 | $144.54 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,202.26 / $1,412.54
| Facility | | $239.88 | $1,202.26 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $208.93 / $389.05
| Professional | | $128.82 | $208.93 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $9,120.11 / $16,982.44
| Facility | | $4,466.84 | $9,120.11 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $123.03 / $281.84
| Professional | | $91.20 | $123.03 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $199.53
| Professional | | $32.36 | $33.11 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $5,623.41 / $9,772.37
| Facility | | $1,905.46 | $5,623.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $190.55 / $331.13
| Professional | | $114.82 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $144.54
| Professional | | $107.15 | $107.15 | $144.54 |