- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $5,011.87 / $8,511.38
| Facility | | $549.54 | $5,011.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $660.69 / $4,168.69
| Professional | | $269.15 | $660.69 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,162.28 / $6,760.83
| Facility | | $2,570.40 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $3,162.28 / $4,677.35
| Professional | | $354.81 | $3,162.28 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $912.01 / $7,244.36
| Professional | | $323.59 | $912.01 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,174.90 / $4,265.80
| Facility | | $281.84 | $1,174.90 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $5,495.41 / $17,782.79
| Professional | | $794.33 | $5,495.41 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $4,466.84 / $7,762.47
| Professional | | $575.44 | $4,466.84 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $4,466.84 / $5,888.44
| Professional | | $512.86 | $4,466.84 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,630.27
| Facility | | $2,238.72 | $2,238.72 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $645.65 / $7,244.36
| Professional | | $3.98 | $645.65 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,630.27 / $6,760.83
| Facility | | $1,479.11 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $794.33 / $5,754.40
| Professional | | $354.81 | $794.33 | $5,754.40 |