- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $4,786.30 / $10,964.78
| Facility | | $1,479.11 | $4,786.30 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $691.83 / $1,819.70
| Professional | | $173.78 | $691.83 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,128.61 / $10,000.00
| Facility | | $3,890.45 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $602.56 / $1,445.44
| Professional | | $199.53 | $602.56 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $660.69 / $2,137.96
| Professional | | $354.81 | $660.69 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,174.90 / $5,754.40
| Facility | | $239.88 | $1,174.90 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,479.11 / $8,709.64
| Professional | | $933.25 | $1,479.11 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,513.56 / $2,041.74
| Professional | | $398.11 | $1,513.56 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $1,584.89
| Professional | | $380.19 | $380.19 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $1,348.96 / $2,089.30
| Professional | | $3.02 | $1,348.96 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,370.32 / $6,760.83
| Facility | | $3,630.78 | $5,370.32 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $870.96 / $1,778.28
| Professional | | $234.42 | $870.96 | $1,778.28 |