- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,981.07 / $10,715.19
| Facility | | $776.25 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $851.14 / $1,905.46
| Professional | | $660.69 | $851.14 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $954.99 / $1,445.44
| Professional | | $691.83 | $954.99 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $3,715.35 / $11,220.18
| Facility | | $870.96 | $3,715.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $794.33 / $912.01
| Professional | | $645.65 | $794.33 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $977.24 / $1,995.26
| Facility | | $436.52 | $977.24 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $891.25 / $1,548.82
| Professional | | $630.96 | $891.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $13,489.63 / $23,988.33
| Facility | | $6,456.54 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $602.56 / $891.25
| Professional | | $537.03 | $602.56 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $676.08 / $1,258.93
| Professional | | $32.36 | $676.08 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,311.31 / $6,606.93
| Facility | | $1,000.00 | $3,311.31 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $794.33 / $1,380.38
| Professional | | $575.44 | $794.33 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $831.76
| Professional | | $616.60 | $616.60 | $831.76 |