- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,445.44 / $5,888.44
| Facility | | $1,071.52 | $1,445.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $977.24 / $3,162.28
| Professional | | $575.44 | $977.24 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $562.34 / $1,659.59
| Professional | | $512.86 | $562.34 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,348.96 / $2,041.74
| Professional | | $870.96 | $1,348.96 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,230.27 / $1,949.84
| Professional | | $794.33 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,288.25 / $1,621.81
| Facility | | $758.58 | $1,288.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,348.96 / $1,737.80
| Professional | | $812.83 | $1,348.96 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $56.23
| Professional | | $32.36 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,230.27 / $1,288.25
| Facility | | $776.25 | $1,230.27 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $870.96
| Facility | | $851.14 | $851.14 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,348.96 / $1,819.70
| Professional | | $870.96 | $1,348.96 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $870.96
| Facility | | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,348.96 / $2,041.74
| Professional | | $870.96 | $1,348.96 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $831.76 / $1,659.59
| Professional | | $588.84 | $831.76 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $870.96 / $1,348.96
| Professional | | $707.95 | $870.96 | $1,348.96 |