- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $7,244.36 / $13,489.63
| Facility | | $707.95 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $562.34 / $1,513.56
| Professional | | $288.40 | $562.34 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $7,585.78 / $14,791.08
| Facility | | $5,754.40 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $512.86 / $691.83
| Professional | | $295.12 | $512.86 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $758.58 / $977.24
| Professional | | $338.84 | $758.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $575.44 / $5,248.07
| Facility | | $338.84 | $575.44 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $660.69 / $3,019.95
| Professional | | $436.52 | $660.69 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $758.58 / $977.24
| Professional | | $691.83 | $758.58 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $794.33
| Professional | | $691.83 | $691.83 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $489.78 / $954.99
| Professional | | $6.03 | $489.78 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,897.79 / $6,760.83
| Facility | | $3,630.78 | $4,897.79 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $851.14
| Professional | | $398.11 | $588.84 | $851.14 |