- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $3,801.89 / $12,589.25
| Facility | | $288.40 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $165.96 / $380.19
| Professional | | $67.61 | $165.96 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $4,677.35 / $9,120.11
| Facility | | $3,548.13 | $4,677.35 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $134.90 / $263.03
| Professional | | $77.62 | $134.90 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $204.17 / $416.87
| Professional | | $131.83 | $204.17 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $204.17 / $3,019.95
| Facility | | $79.43 | $204.17 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $1,047.13
| Professional | | $186.21 | $281.84 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $302.00 / $407.38
| Professional | | $151.36 | $302.00 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $309.03
| Professional | | $151.36 | $151.36 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $123.03 / $389.05
| Professional | | $3.98 | $123.03 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,630.27 / $6,760.83
| Facility | | $1,905.46 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $177.83 / $331.13
| Professional | | $89.13 | $177.83 | $331.13 |