- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $2,630.27 / $5,623.41
| Facility | | $363.08 | $2,630.27 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $575.44 / $4,365.16
| Professional | | $263.03 | $575.44 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $2,511.89
| Professional | | $281.84 | $281.84 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,479.11 / $3,235.94
| Facility | | $758.58 | $1,479.11 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $380.19 / $588.84
| Professional | | $295.12 | $380.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $2,570.40 / $4,073.80
| Professional | | $257.04 | $2,570.40 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,677.35
| Facility | | $1,698.24 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $616.60 / $4,073.80
| Professional | | $281.84 | $616.60 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,380.38 / $4,466.84
| Facility | | $257.04 | $1,380.38 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $3,981.07 / $17,782.79
| Professional | | $691.83 | $3,981.07 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,174.90 / $2,884.03
| Facility | | $954.99 | $1,174.90 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $630.96 / $4,570.88
| Professional | | $269.15 | $630.96 | $4,570.88 |