- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,630.78 / $9,332.54
| Facility | | $758.58 | $3,630.78 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $676.08 / $1,230.27
| Professional | | $501.19 | $676.08 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $758.58 / $1,071.52
| Professional | | $562.34 | $758.58 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $3,467.37 / $5,495.41
| Professional | | $645.65 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $676.08 / $1,258.93
| Professional | | $489.78 | $676.08 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $630.96 / $1,698.24
| Professional | | $524.81 | $630.96 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $831.76 / $1,348.96
| Professional | | $676.08 | $831.76 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $741.31 / $1,047.13
| Facility | | $512.86 | $741.31 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $724.44 / $8,709.64
| Facility | | $478.63 | $724.44 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $724.44 / $8,709.64
| Professional | | $478.63 | $724.44 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,165.95 / $12,882.50
| Facility | | $3,630.78 | $6,165.95 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,096.48
| Professional | | $426.58 | $660.69 | $1,096.48 |