- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $4,786.30 / $8,317.64
| Facility | | $1,047.13 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,047.13 / $1,584.89
| Professional | | $891.25 | $1,047.13 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,570.40 / $57,543.99
| Facility | | $2,344.23 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,000.00 / $1,737.80
| Professional | | $954.99 | $1,000.00 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,023.29 / $1,737.80
| Professional | | $741.31 | $1,023.29 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $870.96 / $1,412.54
| Professional | | $239.88 | $870.96 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $912.01 / $1,548.82
| Professional | | $812.83 | $912.01 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $1,778.28
| Professional | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $3,630.78 / $8,317.64
| Facility | | $831.76 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,047.13 / $1,737.80
| Professional | | $870.96 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,071.52 / $2,187.76
| Professional | | $1,000.00 | $1,071.52 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $933.25
| Facility | | $478.63 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $954.99
| Professional | | $478.63 | $478.63 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $3,019.95 / $7,413.10
| Facility | | $363.08 | $3,019.95 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,023.29 / $1,862.09
| Professional | | $776.25 | $1,023.29 | $1,862.09 |