- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $6,025.60 / $13,489.63
| Facility | | $1,148.15 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,258.93 / $2,818.38
| Professional | | $891.25 | $1,258.93 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,698.24 / $1,995.26
| Professional | | $1,288.25 | $1,698.24 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $4,265.80 / $12,302.69
| Facility | | $1,288.25 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,000.00 / $1,202.26
| Professional | | $776.25 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $12,589.25 / $53,703.18
| Facility | | $1,905.46 | $12,589.25 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,318.26 / $2,691.53
| Professional | | $831.76 | $1,318.26 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $13,489.63 / $23,442.29
| Facility | | $6,165.95 | $13,489.63 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $724.44 / $1,230.27
| Professional | | $602.56 | $724.44 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,122.02
| Professional | | $32.36 | $33.11 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $9,332.54 / $15,848.93
| Facility | | $2,818.38 | $9,332.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,174.90 / $2,089.30
| Professional | | $870.96 | $1,174.90 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $954.99 / $1,122.02
| Professional | | $870.96 | $954.99 | $1,122.02 |