- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $5,754.40 / $8,511.38
| Facility | | $1,047.13 | $5,754.40 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,071.52 / $1,905.46
| Professional | | $912.01 | $1,071.52 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20,417.38 / $21,379.62 / $57,543.99
| Facility | | $20,417.38 | $21,379.62 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,548.82 / $1,548.82
| Professional | | $1,445.44 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $794.33 / $1,737.80
| Facility | | $489.78 | $794.33 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,148.15 / $2,089.30
| Professional | | $691.83 | $1,148.15 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,412.54 / $1,949.84
| Professional | | $1,047.13 | $1,412.54 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,071.52 / $1,698.24
| Professional | | $912.01 | $1,071.52 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $3,981.07 / $8,317.64
| Facility | | $831.76 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,071.52 / $1,659.59
| Professional | | $870.96 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,819.70 / $2,238.72
| Professional | | $851.14 | $1,819.70 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,000.00 / $1,000.00
| Facility | | $812.83 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,000.00 / $1,047.13
| Professional | | $954.99 | $1,000.00 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,290.87 / $6,309.57
| Facility | | $398.11 | $2,290.87 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,122.02 / $1,949.84
| Professional | | $812.83 | $1,122.02 | $1,949.84 |