- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $3,630.78 / $9,549.93
| Facility | | $954.99 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $933.25 / $1,479.11
| Professional | | $758.58 | $933.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $10,471.29 / $13,803.84
| Facility | | $6,606.93 | $10,471.29 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,023.29 / $1,479.11
| Professional | | $776.25 | $1,023.29 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,047.13 / $1,412.54
| Professional | | $831.76 | $1,047.13 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,071.52 / $1,659.59
| Professional | | $794.33 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $912.01 / $2,398.83
| Professional | | $758.58 | $912.01 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,445.44 / $1,862.09
| Professional | | $1,148.15 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,148.15 / $1,778.28
| Facility | | $831.76 | $1,148.15 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,096.48 / $5,248.07
| Facility | | $776.25 | $1,096.48 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,096.48 / $5,248.07
| Professional | | $776.25 | $1,096.48 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,311.31 / $6,309.57
| Facility | | $1,584.89 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,096.48 / $1,659.59
| Professional | | $676.08 | $1,096.48 | $1,659.59 |