- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $2,511.89 / $6,760.83
| Facility | | $630.96 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $851.14 / $2,238.72
| Professional | | $363.08 | $851.14 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,122.02 / $3,162.28
| Professional | | $398.11 | $1,122.02 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,288.25 / $6,606.93
| Professional | | $354.81 | $1,288.25 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,584.89 / $7,943.28
| Facility | | $512.86 | $1,584.89 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $2,884.03 / $15,488.17
| Professional | | $977.24 | $2,884.03 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $2,187.76 / $6,165.95
| Professional | | $851.14 | $2,187.76 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,905.46 / $6,456.54
| Professional | | $812.83 | $1,905.46 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7,244.36 / $8,317.64
| Professional | | $5.01 | $7,244.36 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $6,025.60 / $8,709.64
| Facility | | $2,951.21 | $6,025.60 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $977.24 / $3,890.45
| Professional | | $407.38 | $977.24 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $891.25 / $1,995.26
| Professional | | $724.44 | $891.25 | $1,995.26 |