- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $5,495.41 / $10,715.19
| Facility | | $1,230.27 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,000.00 / $1,621.81
| Professional | | $812.83 | $1,000.00 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $3,311.31
| Professional | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $4,897.79 / $11,220.18
| Facility | | $1,174.90 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,000.00 / $1,148.15
| Professional | | $776.25 | $1,000.00 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $4,677.35 / $5,128.61
| Facility | | $616.60 | $4,677.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,230.27 / $1,995.26
| Professional | | $812.83 | $1,230.27 | $1,995.26 |
- 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
- $549.54 / $741.31 / $1,096.48
| Professional | | $549.54 | $741.31 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,412.54
| Professional | | $32.36 | $33.11 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $9,549.93 / $15,848.93
| Facility | | $3,311.31 | $9,549.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,023.29 / $1,905.46
| Professional | | $707.95 | $1,023.29 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $1,023.29
| Professional | | $691.83 | $691.83 | $1,023.29 |