- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $3,801.89 / $12,589.25
| Facility | | $1,148.15 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $338.84 / $1,148.15
| Professional | | $60.26 | $338.84 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Professional | | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,995.26 / $3,890.45
| Facility | | $1,548.82 | $1,995.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $467.74 / $1,071.52
| Professional | | $74.13 | $467.74 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $380.19 / $1,737.80
| Professional | | $93.33 | $380.19 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $524.81 / $1,380.38
| Facility | | $67.61 | $524.81 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,380.38 / $4,265.80
| Professional | | $741.31 | $1,380.38 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,096.48 / $1,905.46
| Professional | | $141.25 | $1,096.48 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $1,096.48 / $1,348.96
| Professional | | $125.89 | $1,096.48 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $1,047.13 / $1,698.24
| Professional | | $3.98 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,630.27 / $6,760.83
| Facility | | $1,122.02 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $676.08 / $1,412.54
| Professional | | $89.13 | $676.08 | $1,412.54 |