- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $2,511.89 / $6,918.31
| Facility | | $645.65 | $2,511.89 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $457.09 / $3,630.78
| Professional | | $177.83 | $457.09 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $9,772.37 / $19,952.62
| Facility | | $5,495.41 | $9,772.37 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $776.25 / $4,677.35
| Professional | | $416.87 | $776.25 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $436.52 / $457.09
| Facility | | $79.43 | $436.52 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $489.78 / $4,168.69
| Professional | | $218.78 | $489.78 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19,498.45 / $19,498.45 / $48,977.88
| Facility | | $19,498.45 | $19,498.45 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26,302.68 / $31,622.78 / $31,622.78
| Professional | | $26,302.68 | $31,622.78 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $575.44 / $5,248.07
| Facility | | $208.93 | $575.44 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $794.33 / $7,762.47
| Professional | | $239.88 | $794.33 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $389.05
| Professional | | $32.36 | $33.11 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $446.68 / $5,011.87
| Facility | | $199.53 | $446.68 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $501.19 / $4,168.69
| Professional | | $223.87 | $501.19 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $7,413.10 / $16,982.44
| Facility | | $2,570.40 | $7,413.10 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $346.74 / $2,398.83
| Professional | | $162.18 | $346.74 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $4,786.30 / $4,897.79
| Professional | | $4,570.88 | $4,786.30 | $4,897.79 |