- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,235.94 / $6,760.83
| Facility | | $1,174.90 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $812.83 / $1,737.80
| Professional | | $660.69 | $812.83 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,621.81 / $1,995.26
| Professional | | $660.69 | $1,621.81 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,230.27 / $2,691.53
| Professional | | $645.65 | $1,230.27 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,513.56 / $7,079.46
| Facility | | $707.95 | $1,513.56 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,288.25 / $5,128.61
| Professional | | $724.44 | $1,288.25 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,584.89 / $1,862.09
| Professional | | $1,122.02 | $1,584.89 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,380.38 / $1,905.46
| Professional | | $1,023.29 | $1,380.38 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $1,348.96 / $1,819.70
| Professional | | $5.01 | $1,348.96 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $5,888.44 / $7,762.47
| Facility | | $2,951.21 | $5,888.44 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,000.00 / $1,862.09
| Professional | | $676.08 | $1,000.00 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,348.96 / $1,584.89
| Professional | | $1,071.52 | $1,348.96 | $1,584.89 |