- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $4,265.80 / $8,511.38
| Facility | | $691.83 | $4,265.80 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $602.56 / $2,187.76
| Professional | | $316.23 | $602.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $6,606.93 / $12,882.50
| Facility | | $5,128.61 | $6,606.93 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $645.65 / $1,023.29
| Professional | | $398.11 | $645.65 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,023.29 / $1,479.11
| Professional | | $676.08 | $1,023.29 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $776.25 / $4,786.30
| Facility | | $446.68 | $776.25 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,047.13 / $4,073.80
| Professional | | $588.84 | $1,047.13 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,096.48 / $1,479.11
| Professional | | $776.25 | $1,096.48 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,047.13 / $1,174.90
| Professional | | $776.25 | $1,047.13 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,365.16 / $6,760.83
| Facility | | $3,630.78 | $4,365.16 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $741.31 / $1,258.93
| Professional | | $457.09 | $741.31 | $1,258.93 |