- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $6,918.31 / $12,022.64
| Facility | | $977.24 | $6,918.31 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $741.31 / $3,467.37
| Professional | | $630.96 | $741.31 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,365.16 / $16,982.44
| Facility | | $2,238.72 | $4,365.16 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $851.14 / $1,348.96
| Professional | | $616.60 | $851.14 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $741.31
| Facility | | $630.96 | $630.96 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $870.96 / $1,348.96
| Professional | | $575.44 | $870.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $870.96 / $1,348.96
| Professional | | $575.44 | $870.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $426.58
| Professional | | $32.36 | $33.11 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $7,244.36
| Facility | | $100.00 | $100.00 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $724.44 / $1,380.38
| Professional | | $588.84 | $724.44 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,570.88 / $8,709.64
| Facility | | $2,884.03 | $4,570.88 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $776.25 / $1,174.90
| Professional | | $478.63 | $776.25 | $1,174.90 |