- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $5,248.07 / $12,589.25
| Facility | | $2,041.74 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $588.84 / $3,981.07
| Professional | | $234.42 | $588.84 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,467.37 / $6,760.83
| Facility | | $2,691.53 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $977.24 / $4,365.16
| Professional | | $275.42 | $977.24 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $933.25 / $7,244.36
| Professional | | $316.23 | $933.25 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,047.13 / $4,168.69
| Facility | | $251.19 | $1,047.13 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $5,248.07 / $17,378.01
| Professional | | $707.95 | $5,248.07 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $4,365.16 / $7,585.78
| Professional | | $524.81 | $4,365.16 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $4,365.16 / $5,754.40
| Professional | | $467.74 | $4,365.16 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $6,918.31
| Professional | | $3.98 | $3.98 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,630.27 / $6,760.83
| Facility | | $1,479.11 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $707.95 / $5,623.41
| Professional | | $331.13 | $707.95 | $5,623.41 |