- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,023.29 / $1,445.44
| Facility | | $467.74 | $1,023.29 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $630.96 / $1,023.29
| Professional | | $489.78 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $2,570.40
| Facility | | $1,288.25 | $1,288.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $2,187.76
| Professional | | $794.33 | $794.33 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,047.13 / $1,047.13
| Facility | | $977.24 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $53,703.18
| Facility | | $724.44 | $724.44 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $1,513.56
| Professional | | $524.81 | $524.81 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,137.96 / $5,011.87
| Facility | | $1,288.25 | $2,137.96 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,288.25 / $2,454.71
| Professional | | $812.83 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $933.25
| Facility | | $891.25 | $891.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $812.83 / $891.25
| Professional | | $758.58 | $812.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $50,118.72 / $75,857.76
| Facility | | $1,905.46 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,230.27 / $1,230.27
| Professional | | $851.14 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $870.96 / $3,548.13
| Facility | | $489.78 | $870.96 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $831.76 / $2,137.96
| Professional | | $416.87 | $831.76 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $851.14 / $933.25
| Facility | | $758.58 | $851.14 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $812.83 / $891.25
| Professional | | $758.58 | $812.83 | $891.25 |