- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,073.80 / $12,589.25
| Facility | | $2,041.74 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $501.19 / $1,230.27
| Professional | | $457.09 | $501.19 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $10,471.29 / $20,417.38
| Facility | | $7,943.28 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $758.58 / $1,096.48
| Professional | | $446.68 | $758.58 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $954.99 / $1,479.11
| Professional | | $426.58 | $954.99 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $776.25 / $7,762.47
| Facility | | $457.09 | $776.25 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $977.24 / $4,466.84
| Professional | | $549.54 | $977.24 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,122.02 / $1,479.11
| Professional | | $954.99 | $1,122.02 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $954.99 / $1,479.11
| Professional | | $831.76 | $954.99 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $549.54 / $1,202.26
| Professional | | $5.01 | $549.54 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,760.83 / $8,912.51
| Facility | | $3,630.78 | $6,760.83 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $758.58 / $1,258.93
| Professional | | $549.54 | $758.58 | $1,258.93 |