- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $3,162.28 / $10,964.78
| Facility | | $891.25 | $3,162.28 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $812.83 / $1,819.70
| Professional | | $630.96 | $812.83 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,623.41 / $12,882.50
| Facility | | $3,388.44 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $660.69 / $1,380.38
| Professional | | $562.34 | $660.69 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $37,153.52
| Facility | | $977.24 | $977.24 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Professional | | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $1,230.27 / $50,118.72
| Facility | | $34.67 | $1,230.27 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,000.00 / $2,511.89
| Professional | | $616.60 | $1,000.00 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,071.52 / $2,691.53
| Facility | | $741.31 | $1,071.52 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,023.29 / $1,584.89
| Professional | | $776.25 | $1,023.29 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $912.01 / $1,445.44
| Professional | | $549.54 | $912.01 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $50,118.72 / $75,857.76
| Facility | | $691.83 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $912.01 / $1,584.89
| Professional | | $398.11 | $912.01 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $3,981.07 / $8,912.51
| Facility | | $1,412.54 | $3,981.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,122.02 / $8,912.51
| Professional | | $676.08 | $1,122.02 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $812.83 / $2,570.40
| Facility | | $562.34 | $812.83 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $812.83 / $1,737.80
| Professional | | $562.34 | $812.83 | $1,737.80 |