- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $5,011.87 / $12,589.25
| Facility | | $2,344.23 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $194.98 / $891.25
| Professional | | $158.49 | $194.98 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $6,025.60 / $11,748.98
| Facility | | $4,570.88 | $6,025.60 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $257.04 / $380.19
| Professional | | $151.36 | $257.04 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $380.19 / $537.03
| Professional | | $186.21 | $380.19 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $389.05 / $4,466.84
| Facility | | $199.53 | $389.05 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $363.08 / $1,548.82
| Professional | | $239.88 | $363.08 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $416.87 / $549.54
| Professional | | $363.08 | $416.87 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Professional | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $338.84 / $436.52
| Professional | | $6.03 | $338.84 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,691.53 / $6,760.83
| Facility | | $2,187.76 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $323.59 / $446.68
| Professional | | $234.42 | $323.59 | $446.68 |