- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $5,128.61 / $8,317.64
| Facility | | $977.24 | $5,128.61 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $954.99 / $1,819.70
| Professional | | $776.25 | $954.99 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,318.26 / $2,238.72
| Professional | | $870.96 | $1,318.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,288.25 / $5,370.32
| Professional | | $1,000.00 | $1,288.25 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,096.48 / $1,949.84
| Professional | | $831.76 | $1,096.48 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,096.48 / $1,288.25
| Professional | | $851.14 | $1,096.48 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,479.11 / $2,137.96
| Professional | | $1,202.26 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,148.15 / $1,737.80
| Facility | | $870.96 | $1,148.15 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,122.02 / $7,413.10
| Facility | | $851.14 | $1,122.02 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,122.02 / $7,413.10
| Professional | | $851.14 | $1,122.02 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $8,128.31 / $16,982.44
| Facility | | $5,128.61 | $8,128.31 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,071.52 / $1,698.24
| Professional | | $676.08 | $1,071.52 | $1,698.24 |