- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $5,011.87 / $12,589.25
| Facility | | $1,023.29 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $407.38 / $891.25
| Professional | | $165.96 | $407.38 | $891.25 |
- 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
- $190.55 / $371.54 / $851.14
| Professional | | $190.55 | $371.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $512.86 / $1,174.90
| Professional | | $239.88 | $512.86 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $389.05 / $977.24
| Facility | | $177.83 | $389.05 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $933.25 / $3,311.31
| Professional | | $288.40 | $933.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $831.76 / $1,174.90
| Professional | | $323.59 | $831.76 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $691.83 / $1,047.13
| Professional | | $323.59 | $691.83 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $371.54 / $1,258.93
| Professional | | $5.01 | $371.54 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,884.03 / $6,760.83
| Facility | | $2,398.83 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $398.11 / $1,023.29
| Professional | | $223.87 | $398.11 | $1,023.29 |