- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $6,025.60 / $18,620.87
| Facility | | $870.96 | $6,025.60 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $549.54 / $1,174.90
| Professional | | $389.05 | $549.54 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $8,709.64 / $17,378.01
| Facility | | $6,456.54 | $8,709.64 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $891.25 / $1,230.27
| Professional | | $630.96 | $891.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $758.58 / $4,466.84
| Facility | | $630.96 | $758.58 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $758.58 / $1,348.96
| Professional | | $398.11 | $758.58 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $954.99 / $3,890.45
| Facility | | $478.63 | $954.99 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $891.25 / $2,951.21
| Professional | | $426.58 | $891.25 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $208.93
| Professional | | $32.36 | $33.11 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $851.14 / $912.01
| Facility | | $602.56 | $851.14 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $630.96 / $977.24
| Facility | | $616.60 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $933.25 / $1,202.26
| Professional | | $630.96 | $933.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $8,912.51 / $17,378.01
| Facility | | $6,165.95 | $8,912.51 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $891.25 / $1,230.27
| Professional | | $630.96 | $891.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $10,232.93 / $18,620.87
| Facility | | $2,884.03 | $10,232.93 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $630.96 / $1,202.26
| Professional | | $457.09 | $630.96 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $512.86 / $933.25
| Professional | | $489.78 | $512.86 | $933.25 |