- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $5,495.41 / $8,912.51
| Facility | | $1,819.70 | $5,495.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,698.24 / $3,548.13
| Professional | | $512.86 | $1,698.24 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,884.03 / $5,011.87
| Facility | | $2,187.76 | $2,884.03 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $1,659.59
| Professional | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $3,235.94 / $6,309.57
| Facility | | $1,548.82 | $3,235.94 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,398.83 / $4,897.79
| Professional | | $1,122.02 | $2,398.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,905.46 / $3,090.30
| Professional | | $1,000.00 | $1,905.46 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,513.56 / $3,801.89
| Professional | | $446.68 | $1,513.56 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,311.31 / $7,585.78
| Facility | | $1,737.80 | $3,311.31 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,698.24 / $2,454.71
| Professional | | $512.86 | $1,698.24 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $707.95 / $2,137.96
| Facility | | $288.40 | $707.95 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $812.83 / $2,137.96
| Professional | | $288.40 | $812.83 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $2,137.96 / $2,570.40
| Facility | | $302.00 | $2,137.96 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,071.52 / $2,691.53
| Professional | | $363.08 | $1,071.52 | $2,691.53 |