- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $5,011.87 / $12,589.25
| Facility | | $776.25 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $389.05 / $1,584.89
| Professional | | $275.42 | $389.05 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $9,332.54 / $18,197.01
| Facility | | $7,244.36 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $489.78 / $724.44
| Professional | | $288.40 | $489.78 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $812.83 / $891.25
| Professional | | $354.81 | $812.83 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $588.84 / $5,370.32
| Facility | | $338.84 | $588.84 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $2,754.23
| Professional | | $537.03 | $776.25 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $870.96 / $1,122.02
| Professional | | $630.96 | $870.96 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $831.76
| Professional | | $630.96 | $630.96 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $467.74 / $1,000.00
| Professional | | $5.01 | $467.74 | $1,000.00 |
- 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
- $416.87 / $602.56 / $891.25
| Professional | | $416.87 | $602.56 | $891.25 |