- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $3,630.78 / $8,317.64
| Facility | | $588.84 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $588.84 / $1,071.52
| Professional | | $467.74 | $588.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $10,232.93 / $13,489.63
| Facility | | $4,168.69 | $10,232.93 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $741.31 / $1,071.52
| Professional | | $562.34 | $741.31 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $741.31 / $1,023.29
| Professional | | $602.56 | $741.31 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $691.83 / $1,230.27
| Professional | | $489.78 | $691.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $588.84 / $1,584.89
| Professional | | $489.78 | $588.84 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,071.52 / $1,348.96
| Professional | | $831.76 | $1,071.52 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $758.58 / $1,071.52
| Facility | | $524.81 | $758.58 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $758.58 / $5,248.07
| Facility | | $512.86 | $758.58 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $758.58 / $5,248.07
| Professional | | $512.86 | $758.58 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,311.31 / $6,309.57
| Facility | | $1,621.81 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $741.31 / $1,148.15
| Professional | | $478.63 | $741.31 | $1,148.15 |