- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $4,570.88 / $12,302.69
| Facility | | $691.83 | $4,570.88 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $812.83 / $3,019.95
| Professional | | $380.19 | $812.83 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,238.72
| Professional | | $2,041.74 | $2,041.74 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,890.45 / $32,359.37
| Facility | | $2,570.40 | $3,890.45 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,125.38 / $14,125.38 / $57,543.99
| Facility | | $14,125.38 | $14,125.38 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $630.96
| Professional | | $588.84 | $588.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $691.83 / $3,548.13
| Professional | | $389.05 | $691.83 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,981.07 / $4,897.79
| Professional | | $2,884.03 | $3,981.07 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $2,754.23 / $3,890.45
| Professional | | $436.52 | $2,754.23 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $13,182.57 / $23,442.29
| Facility | | $3,548.13 | $13,182.57 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $676.08 / $2,454.71
| Professional | | $457.09 | $676.08 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,162.28 / $9,120.11
| Facility | | $2,290.87 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $2,570.40 / $9,549.93
| Facility | | $512.86 | $2,570.40 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $954.99 / $3,630.78
| Professional | | $389.05 | $954.99 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $851.14 / $4,570.88
| Professional | | $501.19 | $851.14 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $416.87 / $2,187.76
| Facility | | $407.38 | $416.87 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $416.87 / $2,238.72
| Professional | | $407.38 | $416.87 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $6,606.93 / $21,379.62
| Facility | | $3,019.95 | $6,606.93 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,148.15 / $3,019.95
| Professional | | $389.05 | $1,148.15 | $3,019.95 |