- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $6,456.54 / $11,481.54
| Facility | | $724.44 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $741.31 / $1,230.27
| Professional | | $323.59 | $741.31 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $10,471.29 / $20,417.38
| Facility | | $8,128.31 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $537.03 / $776.25
| Professional | | $316.23 | $537.03 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $794.33 / $1,096.48
| Professional | | $588.84 | $794.33 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,348.96 / $8,912.51
| Facility | | $416.87 | $1,348.96 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $812.83 / $7,762.47
| Professional | | $446.68 | $812.83 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $831.76 / $1,096.48
| Professional | | $776.25 | $831.76 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $7,079.46
| Facility | | $6,025.60 | $6,025.60 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $891.25 / $1,202.26
| Professional | | $3.98 | $891.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $6,606.93 / $8,511.38
| Facility | | $4,677.35 | $6,606.93 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $724.44 / $1,000.00
| Professional | | $446.68 | $724.44 | $1,000.00 |