- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,630.78 / $6,025.60
| Facility | | $1,659.59 | $3,630.78 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,659.59 / $3,630.78
| Professional | | $436.52 | $1,659.59 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $5,370.32 / $14,454.40
| Facility | | $56.23 | $5,370.32 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,348.96 / $5,495.41
| Professional | | $436.52 | $1,348.96 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $1,096.48
| Facility | | $478.63 | $478.63 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,995.26 / $3,715.35
| Professional | | $630.96 | $1,995.26 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,659.59 / $5,495.41
| Professional | | $602.56 | $1,659.59 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $549.54 / $3,630.78
| Facility | | $416.87 | $549.54 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,398.83 / $3,388.44
| Professional | | $1,949.84 | $2,398.83 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $6,918.31 / $15,488.17
| Facility | | $3,090.30 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,659.59 / $4,265.80
| Professional | | $457.09 | $1,659.59 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $5,370.32 / $14,454.40
| Facility | | $56.23 | $5,370.32 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,348.96 / $5,495.41
| Professional | | $436.52 | $1,348.96 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $6,165.95 / $26,915.35
| Facility | | $2,884.03 | $6,165.95 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,949.84 / $5,495.41
| Professional | | $524.81 | $1,949.84 | $5,495.41 |