- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,698.24 / $8,709.64
| Facility | | $870.96 | $1,698.24 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $741.31 / $1,380.38
| Professional | | $630.96 | $741.31 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,023.29 / $1,995.26
| Professional | | $724.44 | $1,023.29 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $3,715.35
| Facility | | $602.56 | $602.56 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $912.01 / $1,548.82
| Professional | | $707.95 | $912.01 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,621.81
| Professional | | $1,047.13 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $891.25 / $1,412.54
| Facility | | $676.08 | $891.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,148.15 / $1,348.96
| Professional | | $977.24 | $1,148.15 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $6,760.83 / $10,715.19
| Facility | | $2,344.23 | $6,760.83 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $741.31 / $1,445.44
| Professional | | $562.34 | $741.31 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,022.64 / $12,022.64 / $45,708.82
| Facility | | $12,022.64 | $12,022.64 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $5,888.44 / $6,025.60
| Professional | | $5,888.44 | $5,888.44 | $6,025.60 |