- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $5,011.87 / $12,589.25
| Facility | | $1,000.00 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $575.44 / $2,041.74
| Professional | | $338.84 | $575.44 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $5,495.41 / $10,715.19
| Facility | | $4,168.69 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $660.69 / $954.99
| Professional | | $389.05 | $660.69 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $933.25 / $1,288.25
| Professional | | $446.68 | $933.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $794.33 / $6,456.54
| Facility | | $436.52 | $794.33 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $912.01 / $3,715.35
| Professional | | $602.56 | $912.01 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,047.13 / $1,288.25
| Professional | | $776.25 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $1,096.48
| Professional | | $812.83 | $812.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $660.69 / $1,318.26
| Professional | | $6.03 | $660.69 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,011.87 / $6,760.83
| Facility | | $3,630.78 | $5,011.87 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $724.44 / $1,148.15
| Professional | | $457.09 | $724.44 | $1,148.15 |