- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $3,235.94 / $8,317.64
| Facility | | $851.14 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $977.24 / $2,041.74
| Professional | | $741.31 | $977.24 | $2,041.74 |
- 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
- $851.14 / $1,230.27 / $1,778.28
| Professional | | $851.14 | $1,230.27 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $954.99 / $2,754.23
| Professional | | $812.83 | $954.99 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,071.52 / $1,819.70
| Professional | | $812.83 | $1,071.52 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,230.27 / $1,479.11
| Professional | | $954.99 | $1,230.27 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,288.25
| Professional | | $1,096.48 | $1,096.48 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,071.52 / $1,584.89
| Facility | | $776.25 | $1,071.52 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $4,073.80
| Professional | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,122.02 / $4,073.80
| Facility | | $741.31 | $1,122.02 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,318.26 / $4,786.30
| Professional | | $851.14 | $1,318.26 | $4,786.30 |
- 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
- $691.83 / $977.24 / $1,698.24
| Professional | | $691.83 | $977.24 | $1,698.24 |