- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,073.80 / $12,589.25
| Facility | | $2,041.74 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $309.03 / $758.58
| Professional | | $251.19 | $309.03 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,467.37 / $6,760.83
| Facility | | $2,691.53 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $416.87 / $602.56
| Professional | | $239.88 | $416.87 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $537.03 / $851.14
| Professional | | $302.00 | $537.03 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $426.58 / $3,019.95
| Facility | | $251.19 | $426.58 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $562.34 / $2,041.74
| Professional | | $316.23 | $562.34 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $645.65 / $851.14
| Professional | | $501.19 | $645.65 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $549.54 / $831.76
| Professional | | $478.63 | $549.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $691.83
| Professional | | $3.98 | $3.98 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,630.27 / $6,760.83
| Facility | | $1,479.11 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $707.95
| Professional | | $316.23 | $457.09 | $707.95 |