- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $5,011.87 / $8,511.38
| Facility | | $575.44 | $5,011.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $2,630.27 / $6,918.31
| Professional | | $223.87 | $2,630.27 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $7,244.36 / $14,125.38
| Facility | | $5,495.41 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $2,238.72 / $5,370.32
| Professional | | $275.42 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $2,570.40 / $8,128.31
| Professional | | $501.19 | $2,570.40 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $3,388.44 / $8,709.64
| Facility | | $223.87 | $3,388.44 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $6,606.93 / $9,772.37
| Professional | | $1,778.28 | $6,606.93 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $5,754.40 / $8,912.51
| Professional | | $524.81 | $5,754.40 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $5,888.44
| Professional | | $524.81 | $524.81 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $8,128.31
| Professional | | $5.01 | $5.01 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $7,413.10 / $9,120.11
| Facility | | $6,309.57 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $4,073.80 / $7,413.10
| Professional | | $331.13 | $4,073.80 | $7,413.10 |