- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $5,011.87 / $11,481.54
| Facility | | $389.05 | $5,011.87 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,445.44 / $2,398.83
| Professional | | $309.03 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,897.79 / $13,803.84
| Facility | | $3,890.45 | $4,897.79 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,047.13 / $2,570.40
| Professional | | $371.54 | $1,047.13 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $3,467.37 / $5,495.41
| Professional | | $380.19 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,318.26 / $3,311.31
| Professional | | $346.74 | $1,318.26 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,905.46 / $5,128.61
| Professional | | $295.12 | $1,905.46 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,801.89 / $4,466.84
| Professional | | $3,019.95 | $3,801.89 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,513.56 / $3,715.35
| Facility | | $331.13 | $1,513.56 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $478.63 / $10,000.00
| Facility | | $338.84 | $478.63 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $10,000.00
| Professional | | $1,698.24 | $2,630.27 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $10,471.29 / $26,915.35
| Facility | | $6,456.54 | $10,471.29 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,202.26 / $3,715.35
| Professional | | $309.03 | $1,202.26 | $3,715.35 |