- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $6,606.93 / $20,892.96
| Facility | | $2,290.87 | $6,606.93 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $389.05 / $794.33
| Professional | | $346.74 | $389.05 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $758.58 / $1,071.52
| Professional | | $537.03 | $758.58 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $870.96
| Facility | | $758.58 | $758.58 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $660.69 / $1,174.90
| Professional | | $389.05 | $660.69 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $831.76 / $1,000.00
| Facility | | $575.44 | $831.76 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $831.76 / $1,023.29
| Professional | | $575.44 | $831.76 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $60.26 / $75.86
| Professional | | $32.36 | $60.26 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $758.58 / $758.58
| Facility | | $645.65 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $537.03
| Facility | | $524.81 | $524.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $1,023.29
| Professional | | $537.03 | $776.25 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $758.58 / $1,047.13
| Professional | | $537.03 | $758.58 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $549.54 / $5,754.40
| Facility | | $151.36 | $549.54 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $549.54 / $1,023.29
| Professional | | $389.05 | $549.54 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |