- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,630.27 / $7,762.47
| Facility | | $954.99 | $2,630.27 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $758.58 / $1,412.54
| Professional | | $645.65 | $758.58 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $2,041.74
| Facility | | $1,995.26 | $1,995.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $977.24 / $2,041.74
| Professional | | $758.58 | $977.24 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $1,513.56
| Facility | | $524.81 | $524.81 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $954.99 / $1,584.89
| Professional | | $741.31 | $954.99 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,659.59
| Professional | | $1,071.52 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $912.01 / $1,445.44
| Facility | | $707.95 | $912.01 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,148.15 / $1,445.44
| Professional | | $1,023.29 | $1,148.15 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $6,606.93 / $10,715.19
| Facility | | $1,548.82 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $776.25 / $1,513.56
| Professional | | $602.56 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $4,897.79 / $28,840.32
| Facility | | $4,897.79 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $5,248.07 / $6,309.57
| Professional | | $5,248.07 | $5,248.07 | $6,309.57 |