- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $2,570.40 / $6,918.31
| Facility | | $645.65 | $2,570.40 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $691.83 / $1,122.02
| Professional | | $467.74 | $691.83 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $537.03
| Professional | | $281.84 | $446.68 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,265.80 / $8,317.64
| Facility | | $2,570.40 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $870.96
| Professional | | $407.38 | $602.56 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $446.68 / $446.68
| Facility | | $79.43 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Facility | AS | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $831.76 / $1,318.26
| Professional | | $524.81 | $831.76 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $28,840.32 / $28,840.32
| Facility | | $9,332.54 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Facility | AS | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,888.44 / $5,888.44
| Professional | | $5,011.87 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $870.96 / $3,235.94
| Facility | | $524.81 | $870.96 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $758.58 / $1,318.26
| Professional | | $489.78 | $758.58 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $89.13 / $575.44
| Professional | | $32.36 | $89.13 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,737.80 / $2,630.27
| Professional | | $776.25 | $1,737.80 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $794.33 / $1,380.38
| Facility | | $501.19 | $794.33 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | AS | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $831.76 / $1,318.26
| Professional | | $512.86 | $831.76 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $4,786.30 / $9,120.11
| Facility | | $1,737.80 | $4,786.30 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $691.83 / $1,096.48
| Professional | | $457.09 | $691.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $691.83 / $707.95
| Professional | | $676.08 | $691.83 | $707.95 |