- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,621.81 / $4,897.79
| Facility | | $616.60 | $1,621.81 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $758.58 / $1,148.15
| Professional | | $575.44 | $758.58 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $2,290.87 / $4,786.30
| Facility | | $10.23 | $2,290.87 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $512.86 / $741.31
| Professional | | $5.01 | $512.86 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $933.25 / $933.25
| Facility | | $79.43 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,698.24 / $4,168.69
| Facility | | $616.60 | $1,698.24 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $891.25 / $1,621.81
| Professional | | $478.63 | $891.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $7,079.46 / $7,079.46
| Professional | | $4,677.35 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $933.25 / $1,737.80
| Facility | | $562.34 | $933.25 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $812.83 / $1,380.38
| Professional | | $524.81 | $812.83 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Professional | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,023.29 / $1,995.26
| Professional | | $933.25 | $1,023.29 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $933.25 / $2,290.87
| Facility | | $562.34 | $933.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $954.99 / $1,698.24
| Professional | | $478.63 | $954.99 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $933.25 / $1,122.02
| Facility | | $389.05 | $933.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $933.25
| Professional | | $389.05 | $389.05 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $645.65 / $933.25
| Professional | | $363.08 | $645.65 | $933.25 |