- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $3,890.45 / $12,882.50
| Facility | | $1,023.29 | $3,890.45 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $870.96 / $1,412.54
| Professional | | $741.31 | $870.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $741.31 / $758.58
| Facility | | $79.43 | $741.31 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,096.48 / $1,698.24
| Professional | | $776.25 | $1,096.48 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38,018.94 / $42,657.95 / $42,657.95
| Facility | | $38,018.94 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $7,079.46 / $7,079.46
| Professional | | $6,309.57 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,174.90 / $4,677.35
| Facility | | $794.33 | $1,174.90 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,071.52 / $1,698.24
| Professional | | $758.58 | $1,071.52 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $107.15 / $707.95
| Professional | | $32.36 | $107.15 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $2,818.38 / $2,951.21
| Professional | | $1,047.13 | $2,818.38 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,023.29 / $1,819.70
| Facility | | $758.58 | $1,023.29 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,096.48 / $1,698.24
| Professional | | $758.58 | $1,096.48 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $6,606.93 / $12,589.25
| Facility | | $2,238.72 | $6,606.93 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $870.96 / $1,348.96
| Professional | | $645.65 | $870.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $794.33 / $794.33
| Professional | | $758.58 | $794.33 | $794.33 |