- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,202.26 / $2,570.40
| Facility | | $457.09 | $1,202.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $467.74 / $954.99
| Professional | | $354.81 | $467.74 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $2,187.76
| Facility | | $1,096.48 | $1,096.48 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $1,778.28
| Professional | | $549.54 | $549.54 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $891.25 / $891.25
| Facility | | $831.76 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $891.25
| Professional | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $53,703.18
| Facility | | $549.54 | $549.54 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $1,122.02
| Professional | | $398.11 | $398.11 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,778.28 / $4,168.69
| Facility | | $1,096.48 | $1,778.28 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,096.48 / $2,041.74
| Professional | | $676.08 | $1,096.48 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $794.33
| Facility | | $758.58 | $758.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $676.08 / $758.58
| Professional | | $645.65 | $676.08 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,698.24 / $1,737.80
| Facility | | $1,698.24 | $1,698.24 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $870.96
| Professional | | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $50,118.72 / $75,857.76
| Facility | | $1,621.81 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,047.13 / $1,047.13
| Professional | | $707.95 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $467.74 / $2,454.71
| Facility | | $331.13 | $467.74 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $676.08 / $1,778.28
| Professional | | $354.81 | $676.08 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $660.69 / $794.33
| Facility | | $645.65 | $660.69 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $676.08 / $758.58
| Professional | | $645.65 | $676.08 | $758.58 |