- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $4,897.79 / $4,897.79
| Facility | | $1,071.52 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,071.52 / $3,090.30
| Professional | | $724.44 | $1,071.52 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $2,630.27
| Facility | | $53.70 | $87.10 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,202.26 / $2,137.96
| Professional | | $478.63 | $1,202.26 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,884.03 / $3,388.44
| Professional | | $2,398.83 | $2,884.03 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,174.90 / $2,511.89
| Facility | | $870.96 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,023.29 / $2,089.30
| Professional | | $794.33 | $1,023.29 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,238.72 / $2,238.72
| Facility | | $1,819.70 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Professional | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $1,174.90 / $2,511.89
| Facility | | $87.10 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $1,288.25 / $2,884.03
| Professional | | $79.43 | $1,288.25 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $676.08
| Facility | | $407.38 | $537.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,737.80 / $2,691.53
| Professional | | $912.01 | $1,737.80 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $512.86 / $831.76
| Facility | | $446.68 | $512.86 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $426.58 / $1,318.26
| Professional | | $389.05 | $426.58 | $1,318.26 |