- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $4,466.84 / $5,495.41
| Facility | | $1,621.81 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $912.01
| Professional | | $398.11 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $3,090.30 / $8,511.38
| Facility | | $1,122.02 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $870.96 / $912.01
| Professional | | $758.58 | $870.96 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $2,041.74
| Facility | | $1,905.46 | $1,905.46 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $575.44 / $776.25
| Professional | | $407.38 | $575.44 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $660.69 / $1,122.02
| Facility | | $436.52 | $660.69 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $776.25 / $1,047.13
| Professional | | $691.83 | $776.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $7,244.36 / $10,232.93
| Facility | | $5,495.41 | $7,244.36 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $912.01 / $1,096.48
| Professional | | $660.69 | $912.01 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $524.81 / $5,128.61
| Professional | | $389.05 | $524.81 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $6,165.95 / $7,762.47
| Facility | | $676.08 | $6,165.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $630.96 / $912.01
| Professional | | $407.38 | $630.96 | $912.01 |