- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $4,897.79 / $11,748.98
| Facility | | $630.96 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $602.56 / $1,479.11
| Professional | | $436.52 | $602.56 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,897.79 / $14,454.40
| Facility | | $2,630.27 | $4,897.79 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $501.19 / $1,148.15
| Professional | | $389.05 | $501.19 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $2,398.83 / $10,964.78
| Facility | | $645.65 | $2,398.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Professional | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $4,365.16 / $53,703.18
| Facility | | $776.25 | $4,365.16 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $812.83 / $2,041.74
| Professional | | $436.52 | $812.83 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $724.44 / $1,584.89
| Facility | | $489.78 | $724.44 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $588.84 / $870.96
| Professional | | $436.52 | $588.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $616.60 / $977.24
| Professional | | $371.54 | $616.60 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $5,754.40 / $6,760.83
| Facility | | $5,754.40 | $5,754.40 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $50,118.72 / $75,857.76
| Facility | | $489.78 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $602.56 / $977.24
| Professional | | $398.11 | $602.56 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,981.07 / $8,912.51
| Facility | | $2,137.96 | $3,981.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $602.56 / $1,445.44
| Professional | | $338.84 | $602.56 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $602.56 / $1,513.56
| Facility | | $371.54 | $602.56 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $602.56 / $1,445.44
| Professional | | $371.54 | $602.56 | $1,445.44 |