- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $5,128.61 / $10,964.78
| Facility | | $954.99 | $5,128.61 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $776.25 / $2,089.30
| Professional | | $616.60 | $776.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $8,317.64 / $16,595.87
| Facility | | $4,466.84 | $8,317.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $660.69 / $1,584.89
| Professional | | $524.81 | $660.69 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,398.83 / $10,964.78
| Facility | | $891.25 | $2,398.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $891.25
| Professional | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $4,786.30 / $53,703.18
| Facility | | $1,096.48 | $4,786.30 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,122.02 / $2,818.38
| Professional | | $616.60 | $1,122.02 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $776.25 / $2,238.72
| Facility | | $616.60 | $776.25 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $831.76 / $1,202.26
| Professional | | $602.56 | $831.76 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $870.96 / $1,584.89
| Professional | | $489.78 | $870.96 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $7,943.28 / $21,379.62
| Facility | | $7,943.28 | $7,943.28 | $21,379.62 |
- 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 / $851.14 / $1,380.38
| Professional | | $398.11 | $851.14 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $4,897.79 / $11,481.54
| Facility | | $2,398.83 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $851.14 / $2,041.74
| Professional | | $501.19 | $851.14 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $831.76 / $2,187.76
| Facility | | $524.81 | $831.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $831.76 / $2,041.74
| Professional | | $512.86 | $831.76 | $2,041.74 |