- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $4,466.84 / $18,620.87
| Facility | | $891.25 | $4,466.84 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $524.81 / $1,348.96
| Professional | | $346.74 | $524.81 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $6,165.95 / $12,589.25
| Facility | | $4,466.84 | $6,165.95 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $954.99 / $1,445.44
| Professional | | $645.65 | $954.99 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $2,884.03
| Facility | | $478.63 | $478.63 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $741.31 / $1,479.11
| Professional | | $446.68 | $741.31 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,174.90 / $3,311.31
| Facility | | $489.78 | $1,174.90 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,071.52 / $1,819.70
| Professional | | $489.78 | $1,071.52 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $208.93
| Professional | | $32.36 | $33.11 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $776.25 / $912.01
| Facility | | $512.86 | $776.25 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $645.65
| Facility | | $630.96 | $630.96 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,000.00 / $1,348.96
| Professional | | $645.65 | $1,000.00 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $6,456.54 / $12,589.25
| Facility | | $4,265.80 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $977.24 / $1,548.82
| Professional | | $645.65 | $977.24 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $6,606.93 / $12,882.50
| Facility | | $154.88 | $6,606.93 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $602.56 / $1,202.26
| Professional | | $426.58 | $602.56 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $588.84 / $933.25
| Professional | | $61.66 | $588.84 | $933.25 |