- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,479.11 / $3,090.30
| Facility | | $389.05 | $1,479.11 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $794.33 / $2,344.23
| Professional | | $331.13 | $794.33 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $10,232.93 / $17,378.01
| Facility | | $6,165.95 | $10,232.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,445.44 / $4,786.30
| Professional | | $524.81 | $1,445.44 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,548.13 / $5,754.40
| Facility | | $3,090.30 | $3,548.13 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,778.28 / $4,073.80
| Professional | | $676.08 | $1,778.28 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $2,398.83 / $4,265.80
| Facility | | $338.84 | $2,398.83 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,047.13 / $3,019.95
| Professional | | $741.31 | $1,047.13 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $7,943.28 / $15,135.61
| Facility | | $338.84 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $2,344.23 / $6,165.95
| Professional | | $1,047.13 | $2,344.23 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $1,318.26
| Professional | | $32.36 | $50.12 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $10,715.19 / $17,378.01
| Facility | | $602.56 | $10,715.19 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,621.81 / $3,311.31
| Professional | | $870.96 | $1,621.81 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,412.54 / $4,168.69
| Professional | | $707.95 | $1,412.54 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $16,982.44 / $16,982.44
| Facility | | $11,481.54 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $3,715.35 / $7,943.28
| Professional | | $575.44 | $3,715.35 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $6,309.57
| Professional | | $1,584.89 | $1,584.89 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,801.89 / $7,943.28
| Professional | | $1,659.59 | $3,801.89 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $14,125.38 / $17,378.01
| Facility | | $8,912.51 | $14,125.38 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,258.93 / $4,265.80
| Professional | | $416.87 | $1,258.93 | $4,265.80 |