- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $3,630.78 / $9,549.93
| Facility | | $691.83 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $891.25 / $1,412.54
| Professional | | $691.83 | $891.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $15,848.93 / $20,892.96
| Facility | | $8,709.64 | $15,848.93 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,047.13 / $1,513.56
| Professional | | $794.33 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,071.52 / $1,445.44
| Professional | | $851.14 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,047.13 / $1,737.80
| Professional | | $707.95 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $851.14 / $2,238.72
| Professional | | $707.95 | $851.14 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,380.38 / $1,949.84
| Professional | | $1,096.48 | $1,380.38 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,122.02 / $1,621.81
| Facility | | $707.95 | $1,122.02 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,096.48 / $5,248.07
| Facility | | $758.58 | $1,096.48 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,096.48 / $5,248.07
| Professional | | $758.58 | $1,096.48 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,311.31 / $6,309.57
| Facility | | $1,584.89 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,047.13 / $1,621.81
| Professional | | $676.08 | $1,047.13 | $1,621.81 |