- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $3,890.45 / $12,882.50
| Facility | | $1,071.52 | $3,890.45 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,000.00 / $1,621.81
| Professional | | $794.33 | $1,000.00 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $6,025.60 / $11,748.98
| Facility | | $3,235.94 | $6,025.60 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $977.24 / $1,288.25
| Professional | | $776.25 | $977.24 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,981.07 / $3,981.07
| Facility | | $707.95 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,096.48 / $1,621.81
| Professional | | $812.83 | $1,096.48 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,302.69 / $42,657.95 / $42,657.95
| Facility | | $12,302.69 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $6,918.31 / $6,918.31
| Professional | | $6,165.95 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,230.27 / $6,456.54
| Facility | | $794.33 | $1,230.27 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,122.02 / $1,995.26
| Professional | | $851.14 | $1,122.02 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $2,137.96
| Professional | | $32.36 | $33.11 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Professional | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $954.99 / $1,737.80
| Facility | | $758.58 | $954.99 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,096.48 / $1,659.59
| Professional | | $794.33 | $1,096.48 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $3,548.13 / $7,244.36
| Facility | | $1,380.38 | $3,548.13 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $870.96 / $1,288.25
| Professional | | $660.69 | $870.96 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $741.31 / $741.31
| Professional | | $707.95 | $741.31 | $741.31 |