- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,818.38 / $2,818.38
| Facility | | $2,570.40 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,548.13 / $5,011.87
| Professional | | $2,818.38 | $3,548.13 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $562.34 / $1,412.54
| Facility | | $446.68 | $562.34 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,466.84 / $17,378.01
| Professional | | $3,467.37 | $4,466.84 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,071.52 / $1,862.09
| Facility | | $331.13 | $1,071.52 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $7,079.46 / $9,772.37
| Professional | | $5,248.07 | $7,079.46 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $426.58 / $6,309.57
| Facility | | $95.50 | $426.58 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $4,677.35 / $6,760.83
| Professional | | $512.86 | $4,677.35 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $8,912.51
| Professional | | $7,413.10 | $7,413.10 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $831.76 / $5,888.44
| Professional | | $398.11 | $831.76 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $30,199.52 / $30,199.52
| Facility | | $100.00 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $7,244.36
| Professional | | $575.44 | $575.44 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $3,235.94 / $7,762.47
| Facility | | $575.44 | $3,235.94 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $4,677.35 / $4,677.35
| Professional | | $426.58 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $8,128.31 / $12,589.25
| Professional | | $7,413.10 | $8,128.31 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $2,137.96 / $3,801.89
| Facility | | $275.42 | $2,137.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,311.31 / $6,760.83
| Professional | | $2,630.27 | $3,311.31 | $6,760.83 |