- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $5,011.87 / $12,589.25
| Facility | | $954.99 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $954.99
| Professional | | $316.23 | $457.09 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $6,606.93 / $12,882.50
| Facility | | $5,128.61 | $6,606.93 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $588.84 / $851.14
| Professional | | $346.74 | $588.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $758.58 / $1,380.38
| Professional | | $371.54 | $758.58 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $537.03 / $1,071.52
| Facility | | $346.74 | $537.03 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $977.24 / $3,311.31
| Professional | | $524.81 | $977.24 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,023.29 / $1,348.96
| Professional | | $724.44 | $1,023.29 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $831.76 / $1,071.52
| Professional | | $630.96 | $831.76 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $588.84 / $1,230.27
| Professional | | $5.01 | $588.84 | $1,230.27 |
- 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
- $407.38 / $645.65 / $1,047.13
| Professional | | $407.38 | $645.65 | $1,047.13 |