- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $4,897.79 / $11,220.18
| Facility | | $1,047.13 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $794.33 / $1,412.54
| Professional | | $645.65 | $794.33 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $933.25
| Professional | | $645.65 | $645.65 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $4,466.84 / $11,220.18
| Facility | | $758.58 | $4,466.84 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $724.44 / $812.83
| Professional | | $575.44 | $724.44 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,187.76 / $3,235.94
| Facility | | $691.83 | $2,187.76 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $912.01 / $1,513.56
| Professional | | $575.44 | $912.01 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $12,882.50 / $23,442.29
| Facility | | $6,025.60 | $12,882.50 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $549.54 / $870.96
| Professional | | $354.81 | $549.54 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $933.25
| Professional | | $32.36 | $33.11 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $8,912.51 / $15,848.93
| Facility | | $2,818.38 | $8,912.51 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $758.58 / $1,318.26
| Professional | | $537.03 | $758.58 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $758.58
| Professional | | $575.44 | $575.44 | $758.58 |