- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $3,801.89 / $13,803.84
| Facility | | $549.54 | $3,801.89 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $354.81 / $10,715.19
| Professional | | $83.18 | $354.81 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $138.04 / $7,244.36
| Professional | | $117.49 | $138.04 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,882.50 / $16,595.87 / $32,359.37
| Facility | | $12,882.50 | $16,595.87 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $3,311.31 / $7,943.28
| Professional | | $93.33 | $3,311.31 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $8,511.38 / $13,182.57
| Professional | | $199.53 | $8,511.38 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $7,943.28 / $13,803.84
| Facility | | $131.83 | $7,943.28 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $10,000.00 / $15,135.61
| Professional | | $6,025.60 | $10,000.00 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $7,762.47 / $13,182.57
| Professional | | $186.21 | $7,762.47 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $8,709.64
| Professional | | $181.97 | $181.97 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $10,232.93 / $14,125.38
| Facility | | $8,317.64 | $10,232.93 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $5,888.44 / $10,964.78
| Professional | | $123.03 | $5,888.44 | $10,964.78 |