- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $7,943.28 / $14,454.40
| Facility | | $6,025.60 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $630.96 / $1,445.44
| Professional | | $537.03 | $630.96 | $1,445.44 |
- 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
- $524.81 / $891.25 / $1,288.25
| Professional | | $524.81 | $891.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,148.15 / $1,905.46
| Professional | | $380.19 | $1,148.15 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $870.96 / $5,370.32
| Facility | | $537.03 | $870.96 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,122.02 / $4,677.35
| Professional | | $676.08 | $1,122.02 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,348.96 / $1,905.46
| Professional | | $1,122.02 | $1,348.96 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,148.15 / $1,905.46
| Professional | | $1,000.00 | $1,148.15 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $812.83 / $1,548.82
| Professional | | $5.01 | $812.83 | $1,548.82 |
- 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
- $676.08 / $891.25 / $1,479.11
| Professional | | $676.08 | $891.25 | $1,479.11 |