- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,905.46 / $6,456.54
| Facility | | $645.65 | $1,905.46 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,000.00 / $3,548.13
| Professional | | $660.69 | $1,000.00 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,737.80 / $3,981.07
| Professional | | $912.01 | $1,737.80 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,884.03 / $4,570.88
| Facility | | $2,454.71 | $2,884.03 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,479.11 / $2,511.89
| Professional | | $831.76 | $1,479.11 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,089.30 / $5,128.61
| Facility | | $741.31 | $2,089.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,041.74 / $2,754.23
| Professional | | $1,412.54 | $2,041.74 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,089.30 / $5,248.07
| Facility | | $776.25 | $2,089.30 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,698.24 / $5,623.41
| Professional | | $933.25 | $1,698.24 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $2,290.87
| Professional | | $32.36 | $33.11 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $3,890.45 / $4,570.88
| Facility | | $1,548.82 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,187.76 / $3,388.44
| Professional | | $1,023.29 | $2,187.76 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,089.30 / $3,019.95
| Professional | | $1,258.93 | $2,089.30 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $5,623.41 / $5,623.41
| Facility | | $3,801.89 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,412.54 / $6,760.83
| Professional | | $794.33 | $1,412.54 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,698.24
| Professional | | $1,412.54 | $1,412.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,235.94 / $4,073.80
| Professional | | $1,621.81 | $3,235.94 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,548.13 / $6,918.31
| Facility | | $2,884.03 | $3,548.13 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $1,995.26 / $4,570.88
| Professional | | $95.50 | $1,995.26 | $4,570.88 |