- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $5,011.87 / $12,589.25
| Facility | | $660.69 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $323.59 / $660.69
| Professional | | $245.47 | $323.59 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $9,332.54 / $18,197.01
| Facility | | $7,244.36 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $446.68 / $630.96
| Professional | | $257.04 | $446.68 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $575.44 / $1,023.29
| Professional | | $275.42 | $575.44 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $416.87 / $758.58
| Facility | | $263.03 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $676.08 / $2,454.71
| Professional | | $371.54 | $676.08 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $741.31 / $933.25
| Professional | | $575.44 | $741.31 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $616.60 / $794.33
| Professional | | $489.78 | $616.60 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $467.74 / $870.96
| Professional | | $5.01 | $467.74 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,760.83 / $8,912.51
| Facility | | $3,630.78 | $6,760.83 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $457.09 / $758.58
| Professional | | $309.03 | $457.09 | $758.58 |