- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $3,311.31 / $7,762.47
| Facility | | $588.84 | $3,311.31 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $501.19 / $1,513.56
| Professional | | $389.05 | $501.19 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,495.41 / $12,882.50
| Facility | | $3,388.44 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $426.58 / $1,023.29
| Professional | | $338.84 | $426.58 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,258.93 / $4,073.80
| Facility | | $575.44 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Professional | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $3,801.89 / $53,703.18
| Facility | | $691.83 | $3,801.89 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $794.33 / $1,819.70
| Professional | | $416.87 | $794.33 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $467.74 / $1,445.44
| Facility | | $371.54 | $467.74 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $537.03 / $794.33
| Professional | | $398.11 | $537.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $562.34 / $870.96
| Professional | | $316.23 | $562.34 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $50,118.72 / $75,857.76
| Facility | | $446.68 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $549.54 / $891.25
| Professional | | $398.11 | $549.54 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,467.37 / $7,943.28
| Facility | | $1,862.09 | $3,467.37 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $537.03 / $1,348.96
| Professional | | $323.59 | $537.03 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $537.03 / $1,412.54
| Facility | | $338.84 | $537.03 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $537.03 / $1,288.25
| Professional | | $331.13 | $537.03 | $1,288.25 |