- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $5,370.32 / $7,943.28
| Facility | | $831.76 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $562.34 / $1,071.52
| Professional | | $457.09 | $562.34 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,148.15 / $1,445.44
| Professional | | $478.63 | $1,148.15 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,047.13 / $1,659.59
| Professional | | $467.74 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,096.48 / $7,413.10
| Facility | | $524.81 | $1,096.48 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $870.96 / $3,715.35
| Professional | | $512.86 | $870.96 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,096.48 / $1,348.96
| Professional | | $794.33 | $1,096.48 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $933.25 / $1,348.96
| Professional | | $776.25 | $933.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $933.25 / $1,318.26
| Professional | | $5.01 | $933.25 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,456.54 / $9,772.37
| Facility | | $3,630.78 | $6,456.54 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $691.83 / $1,318.26
| Professional | | $489.78 | $691.83 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,000.00 / $1,174.90
| Professional | | $776.25 | $1,000.00 | $1,174.90 |