- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,288.25 / $6,165.95
| Facility | | $1,148.15 | $1,288.25 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,071.52 / $6,165.95
| Professional | | $691.83 | $1,071.52 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $2,187.76 / $4,677.35
| Facility | | $436.52 | $2,187.76 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $2,818.38 / $5,888.44
| Professional | | $371.54 | $2,818.38 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,137.96 / $2,754.23
| Facility | | $676.08 | $2,137.96 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $741.31 / $1,862.09
| Professional | | $549.54 | $741.31 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,659.59 / $3,162.28
| Facility | | $660.69 | $1,659.59 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $741.31 / $1,905.46
| Professional | | $467.74 | $741.31 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,023.29 / $1,258.93
| Professional | | $933.25 | $1,023.29 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $977.24 / $1,621.81
| Professional | | $741.31 | $977.24 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $7,079.46 / $7,079.46
| Professional | | $4,677.35 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,122.02 / $2,398.83
| Facility | | $562.34 | $1,122.02 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,000.00 / $1,862.09
| Professional | | $501.19 | $1,000.00 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $3,311.31
| Professional | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $562.34 / $933.25
| Facility | | $416.87 | $562.34 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $407.38 / $1,737.80
| Professional | | $389.05 | $407.38 | $1,737.80 |