- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $5,888.44 / $10,964.78
| Facility | | $831.76 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $467.74 / $3,801.89
| Professional | | $416.87 | $467.74 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,388.44 / $15,135.61
| Facility | | $1,698.24 | $3,388.44 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $588.84 / $977.24
| Professional | | $426.58 | $588.84 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $512.86
| Facility | | $436.52 | $436.52 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $724.44 / $21,379.62
| Facility | | $512.86 | $724.44 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $616.60 / $912.01
| Professional | | $398.11 | $616.60 | $912.01 |
- 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
- $398.11 / $602.56 / $912.01
| Professional | | $398.11 | $602.56 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $3,981.07
| Facility | | $100.00 | $100.00 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $501.19 / $954.99
| Professional | | $407.38 | $501.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,466.84 / $7,762.47
| Facility | | $2,454.71 | $4,466.84 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $512.86 / $794.33
| Professional | | $323.59 | $512.86 | $794.33 |