- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,235.94 / $6,760.83
| Facility | | $758.58 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $524.81 / $1,047.13
| Professional | | $426.58 | $524.81 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,047.13 / $1,318.26
| Professional | | $436.52 | $1,047.13 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $912.01 / $2,398.83
| Professional | | $426.58 | $912.01 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,023.29 / $9,332.54
| Facility | | $478.63 | $1,023.29 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $851.14 / $3,388.44
| Professional | | $478.63 | $851.14 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,023.29 / $1,258.93
| Professional | | $741.31 | $1,023.29 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $891.25 / $1,258.93
| Professional | | $758.58 | $891.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $912.01 / $1,202.26
| Professional | | $3.02 | $912.01 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $7,413.10 / $10,232.93
| Facility | | $3,715.35 | $7,413.10 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $645.65 / $1,202.26
| Professional | | $446.68 | $645.65 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,071.52
| Professional | | $724.44 | $912.01 | $1,071.52 |