- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,890.45 / $8,912.51
| Facility | | $776.25 | $3,890.45 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,023.29 / $2,187.76
| Professional | | $263.03 | $1,023.29 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $234.42 / $524.81
| Professional | | $204.17 | $234.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $3,311.31 / $11,220.18
| Facility | | $891.25 | $3,311.31 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,023.29 / $1,445.44
| Professional | | $251.19 | $1,023.29 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $426.58 / $4,073.80
| Facility | | $323.59 | $426.58 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $977.24 / $2,511.89
| Professional | | $288.40 | $977.24 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $9,120.11 / $16,982.44
| Facility | | $4,466.84 | $9,120.11 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $954.99 / $1,737.80
| Professional | | $831.76 | $954.99 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $169.82 / $1,148.15
| Professional | | $32.36 | $169.82 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $6,760.83 / $12,022.64
| Facility | | $1,995.26 | $6,760.83 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,023.29 / $2,398.83
| Professional | | $257.04 | $1,023.29 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $933.25 / $1,258.93
| Professional | | $190.55 | $933.25 | $1,258.93 |