- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $7,244.36 / $13,489.63
| Facility | | $912.01 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $501.19 / $1,819.70
| Professional | | $323.59 | $501.19 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $8,511.38 / $16,595.87
| Facility | | $6,456.54 | $8,511.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $588.84 / $870.96
| Professional | | $346.74 | $588.84 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $954.99 / $1,071.52
| Professional | | $457.09 | $954.99 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $575.44 / $4,786.30
| Facility | | $363.08 | $575.44 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $851.14 / $3,388.44
| Professional | | $478.63 | $851.14 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $977.24 / $1,230.27
| Professional | | $724.44 | $977.24 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,000.00 / $1,380.38
| Professional | | $645.65 | $1,000.00 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $6,309.57 / $7,585.78
| Facility | | $4,073.80 | $6,309.57 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $645.65 / $1,047.13
| Professional | | $380.19 | $645.65 | $1,047.13 |