- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $5,888.44 / $10,964.78
| Facility | | $954.99 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $891.25 / $1,862.09
| Professional | | $776.25 | $891.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $13,182.57 / $15,488.17
| Facility | | $9,772.37 | $13,182.57 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,230.27 / $2,089.30
| Professional | | $812.83 | $1,230.27 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,230.27 / $14,454.40
| Professional | | $954.99 | $1,230.27 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,071.52 / $1,819.70
| Professional | | $812.83 | $1,071.52 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $977.24 / $1,148.15
| Professional | | $758.58 | $977.24 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,479.11 / $1,949.84
| Professional | | $1,174.90 | $1,479.11 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,096.48 / $1,698.24
| Facility | | $831.76 | $1,096.48 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Professional | | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,096.48 / $10,000.00
| Facility | | $812.83 | $1,096.48 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,096.48 / $10,000.00
| Professional | | $812.83 | $1,096.48 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $11,748.98 / $26,302.68
| Facility | | $7,413.10 | $11,748.98 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,023.29 / $1,621.81
| Professional | | $660.69 | $1,023.29 | $1,621.81 |