- 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
- $33.88 / $39.81 / $199.53
| Professional | | $33.88 | $39.81 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,951.21 / $5,754.40
| Facility | | $2,238.72 | $2,951.21 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $57.54 / $83.18
| Professional | | $33.88 | $57.54 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $85.11 / $117.49
| Professional | | $40.74 | $85.11 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $85.11 / $6,456.54
| Facility | | $44.67 | $85.11 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $912.01
| Professional | | $50.12 | $79.43 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $91.20 / $117.49
| Professional | | $81.28 | $91.20 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Professional | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $70.79 / $93.33
| Professional | | $3.02 | $70.79 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,630.78 / $6,760.83
| Facility | | $2,570.40 | $3,630.78 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $95.50
| Professional | | $50.12 | $72.44 | $95.50 |