- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $3,801.89 / $12,589.25
| Facility | | $398.11 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $177.83 / $363.08
| Professional | | $79.43 | $177.83 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $4,073.80 / $7,943.28
| Facility | | $3,090.30 | $4,073.80 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $169.82 / $354.81
| Professional | | $91.20 | $169.82 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $251.19 / $575.44
| Professional | | $114.82 | $251.19 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $177.83 / $457.09
| Facility | | $85.11 | $177.83 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $1,412.54
| Professional | | $199.53 | $398.11 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $354.81 / $537.03
| Professional | | $177.83 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $316.23 / $457.09
| Professional | | $154.88 | $316.23 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $524.81
| Professional | | $5.01 | $5.01 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,630.27 / $6,760.83
| Facility | | $1,122.02 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $218.78 / $436.52
| Professional | | $107.15 | $218.78 | $436.52 |