- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $5,011.87 / $25,118.86
| Facility | | $758.58 | $5,011.87 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $794.33 / $1,348.96
| Professional | | $676.08 | $794.33 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $10,964.78 / $14,791.08
| Facility | | $6,918.31 | $10,964.78 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $891.25 / $1,288.25
| Professional | | $676.08 | $891.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,230.27
| Professional | | $724.44 | $912.01 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $912.01 / $1,445.44
| Professional | | $645.65 | $912.01 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $758.58 / $1,949.84
| Professional | | $630.96 | $758.58 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,122.02 / $1,659.59
| Professional | | $891.25 | $1,122.02 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,023.29 / $1,479.11
| Facility | | $707.95 | $1,023.29 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $954.99 / $8,709.64
| Facility | | $645.65 | $954.99 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $954.99 / $8,709.64
| Professional | | $645.65 | $954.99 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $6,025.60 / $12,882.50
| Facility | | $3,548.13 | $6,025.60 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $891.25 / $1,445.44
| Professional | | $602.56 | $891.25 | $1,445.44 |