- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $5,011.87 / $12,589.25
| Facility | | $1,513.56 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $741.31 / $1,348.96
| Professional | | $199.53 | $741.31 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $7,244.36 / $14,125.38
| Facility | | $5,495.41 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $630.96 / $1,445.44
| Professional | | $234.42 | $630.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $831.76 / $2,290.87
| Professional | | $288.40 | $831.76 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $741.31 / $1,819.70
| Facility | | $213.80 | $741.31 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,905.46 / $5,754.40
| Professional | | $1,000.00 | $1,905.46 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,445.44 / $2,570.40
| Professional | | $446.68 | $1,445.44 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,445.44 / $1,819.70
| Professional | | $398.11 | $1,445.44 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $1,445.44 / $2,290.87
| Professional | | $3.98 | $1,445.44 | $2,290.87 |
- 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
- $281.84 / $912.01 / $1,949.84
| Professional | | $281.84 | $912.01 | $1,949.84 |