- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,073.80 / $12,589.25
| Facility | | $2,041.74 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $602.56 / $2,884.03
| Professional | | $478.63 | $602.56 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $7,244.36 / $14,125.38
| Facility | | $5,623.41 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $794.33 / $1,122.02
| Professional | | $467.74 | $794.33 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,230.27 / $1,584.89
| Professional | | $575.44 | $1,230.27 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $851.14 / $4,265.80
| Facility | | $478.63 | $851.14 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,071.52 / $3,890.45
| Professional | | $676.08 | $1,071.52 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,230.27 / $1,584.89
| Professional | | $1,148.15 | $1,230.27 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $870.96 / $1,318.26
| Professional | | $6.03 | $870.96 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,548.82 / $5,248.07
| Facility | | $295.12 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $977.24 / $1,318.26
| Professional | | $676.08 | $977.24 | $1,318.26 |