- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $776.25 / $8,709.64
| Facility | | $524.81 | $776.25 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $524.81 / $1,096.48
| Professional | | $380.19 | $524.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $691.83 / $1,288.25
| Professional | | $467.74 | $691.83 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $5,248.07
| Facility | | $602.56 | $602.56 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $1,096.48
| Professional | | $407.38 | $602.56 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $1,202.26
| Professional | | $707.95 | $707.95 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $575.44 / $933.25
| Facility | | $389.05 | $575.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,000.00 / $1,258.93
| Professional | | $776.25 | $1,000.00 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $6,918.31 / $10,715.19
| Facility | | $2,344.23 | $6,918.31 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $489.78 / $912.01
| Professional | | $338.84 | $489.78 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16,982.44 / $16,982.44 / $45,708.82
| Facility | | $16,982.44 | $16,982.44 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $4,677.35
| Professional | | $3,981.07 | $3,981.07 | $4,677.35 |