- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $5,128.61 / $10,471.29
| Facility | | $1,000.00 | $5,128.61 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,148.15 / $3,019.95
| Professional | | $338.84 | $1,148.15 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $426.58 / $562.34
| Professional | | $295.12 | $426.58 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $4,168.69 / $12,302.69
| Facility | | $1,445.44 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,174.90 / $1,659.59
| Professional | | $331.13 | $1,174.90 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,584.89 / $1,905.46
| Facility | | $323.59 | $1,584.89 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,023.29 / $2,754.23
| Professional | | $338.84 | $1,023.29 | $2,754.23 |
- 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
- $954.99 / $1,023.29 / $1,778.28
| Professional | | $954.99 | $1,023.29 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,737.80
| Professional | | $32.36 | $33.11 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $7,413.10 / $12,302.69
| Facility | | $2,630.27 | $7,413.10 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,174.90 / $2,818.38
| Professional | | $354.81 | $1,174.90 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,096.48 / $1,445.44
| Professional | | $257.04 | $1,096.48 | $1,445.44 |