- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $3,162.28 / $23,442.29
| Facility | | $660.69 | $3,162.28 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,513.56 / $3,019.95
| Professional | | $331.13 | $1,513.56 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $489.78 / $1,096.48
| Professional | | $134.90 | $489.78 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,897.79 / $11,748.98
| Facility | | $2,238.72 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $707.95 / $2,818.38
| Professional | | $363.08 | $707.95 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,905.46 / $2,818.38
| Professional | | $316.23 | $1,905.46 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $17,378.01 / $29,512.09
| Facility | | $8,511.38 | $17,378.01 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $891.25 / $3,467.37
| Professional | | $363.08 | $891.25 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,288.25 / $4,466.84
| Facility | | $363.08 | $1,288.25 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,630.78 / $13,182.57
| Professional | | $1,862.09 | $3,630.78 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $707.95 / $2,691.53
| Facility | | $338.84 | $707.95 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,445.44 / $3,388.44
| Professional | | $346.74 | $1,445.44 | $3,388.44 |