- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $3,090.30 / $3,715.35
| Facility | | $389.05 | $3,090.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,445.44 / $3,235.94
| Professional | | $331.13 | $1,445.44 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,584.89 / $1,584.89
| Facility | | $1,202.26 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $2,041.74 / $7,244.36
| Professional | | $489.78 | $2,041.74 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $5,623.41 / $8,912.51
| Facility | | $4,786.30 | $5,623.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,479.11 / $6,456.54
| Professional | | $501.19 | $1,479.11 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,995.26 / $3,801.89
| Facility | | $389.05 | $1,995.26 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,071.52 / $5,370.32
| Professional | | $616.60 | $1,071.52 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,380.38 / $3,548.13
| Facility | | $389.05 | $1,380.38 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $4,365.16 / $13,182.57
| Professional | | $1,949.84 | $4,365.16 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $436.52
| Professional | | $32.36 | $33.11 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $891.25 / $2,344.23
| Facility | | $645.65 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,691.53 / $6,456.54
| Professional | | $741.31 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $2,137.96 / $6,760.83
| Professional | | $562.34 | $2,137.96 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $8,709.64 / $8,709.64
| Facility | | $812.83 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $6,918.31 / $13,182.57
| Professional | | $549.54 | $6,918.31 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $9,549.93
| Professional | | $1,584.89 | $1,584.89 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,454.71 / $12,589.25
| Professional | | $1,348.96 | $2,454.71 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,659.59 / $3,467.37
| Facility | | $1,023.29 | $1,659.59 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,445.44 / $5,888.44
| Professional | | $204.17 | $1,445.44 | $5,888.44 |