- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $7,943.28 / $15,135.61
| Facility | | $4,570.88 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,000.00 / $2,137.96
| Professional | | $851.14 | $1,000.00 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $10,232.93 / $19,952.62
| Facility | | $7,762.47 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,412.54 / $1,949.84
| Professional | | $812.83 | $1,412.54 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,778.28 / $3,019.95
| Professional | | $575.44 | $1,778.28 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,380.38 / $5,370.32
| Facility | | $851.14 | $1,380.38 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,778.28 / $7,244.36
| Professional | | $1,023.29 | $1,778.28 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,137.96 / $3,019.95
| Professional | | $1,778.28 | $2,137.96 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,819.70 / $3,019.95
| Professional | | $1,584.89 | $1,819.70 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $1,348.96 / $2,454.71
| Professional | | $6.03 | $1,348.96 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $5,370.32 / $7,585.78
| Facility | | $4,466.84 | $5,370.32 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,412.54 / $2,344.23
| Professional | | $1,047.13 | $1,412.54 | $2,344.23 |