- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $6,165.95 / $11,481.54
| Facility | | $1,905.46 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $676.08 / $1,737.80
| Professional | | $288.40 | $676.08 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $512.86
| Professional | | $263.03 | $263.03 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $6,165.95 / $12,022.64
| Facility | | $4,677.35 | $6,165.95 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $588.84 / $912.01
| Professional | | $363.08 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $912.01 / $1,380.38
| Professional | | $501.19 | $912.01 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $691.83 / $1,995.26
| Facility | | $380.19 | $691.83 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $870.96 / $3,467.37
| Professional | | $524.81 | $870.96 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $954.99 / $1,380.38
| Professional | | $691.83 | $954.99 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $954.99 / $1,445.44
| Professional | | $602.56 | $954.99 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,630.78 / $6,760.83
| Facility | | $1,995.26 | $3,630.78 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $645.65 / $1,122.02
| Professional | | $380.19 | $645.65 | $1,122.02 |