- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $3,311.31 / $7,943.28
| Facility | | $954.99 | $3,311.31 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $912.01 / $1,513.56
| Professional | | $691.83 | $912.01 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,148.15 / $1,659.59
| Professional | | $812.83 | $1,148.15 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $891.25 / $4,365.16
| Professional | | $758.58 | $891.25 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $977.24 / $1,621.81
| Professional | | $758.58 | $977.24 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,122.02 / $1,318.26
| Professional | | $851.14 | $1,122.02 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,230.27
| Professional | | $1,047.13 | $1,047.13 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $977.24 / $1,548.82
| Facility | | $724.44 | $977.24 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $3,981.07
| Professional | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,047.13 / $4,073.80
| Facility | | $691.83 | $1,047.13 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,230.27 / $4,466.84
| Professional | | $758.58 | $1,230.27 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,162.28 / $5,754.40
| Facility | | $1,698.24 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $933.25 / $1,584.89
| Professional | | $645.65 | $933.25 | $1,584.89 |