- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $776.25 / $6,456.54
| Facility | | $0.87 | $776.25 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $707.95 / $2,187.76
| Professional | | $616.60 | $707.95 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $7,762.47 / $12,589.25
| Facility | | $3,981.07 | $7,762.47 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,412.54 / $3,388.44
| Professional | | $645.65 | $1,412.54 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,137.96 / $3,388.44
| Facility | | $1,819.70 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $2,884.03 / $3,467.37
| Professional | | $851.14 | $2,884.03 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,380.38 / $5,754.40
| Facility | | $676.08 | $1,380.38 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,621.81 / $2,041.74
| Professional | | $1,202.26 | $1,621.81 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,412.54 / $6,165.95
| Facility | | $676.08 | $1,412.54 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,202.26 / $5,011.87
| Professional | | $676.08 | $1,202.26 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $3,890.45 / $4,570.88
| Facility | | $1,288.25 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,513.56 / $2,570.40
| Professional | | $831.76 | $1,513.56 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,548.82 / $2,238.72
| Professional | | $1,023.29 | $1,548.82 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $6,025.60 / $8,912.51
| Facility | | $3,235.94 | $6,025.60 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $3,090.30 / $4,897.79
| Professional | | $1,202.26 | $3,090.30 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Professional | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,801.89 / $4,365.16
| Professional | | $1,819.70 | $3,801.89 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,548.13 / $7,244.36
| Facility | | $2,884.03 | $3,548.13 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,000.00 / $2,630.27
| Professional | | $645.65 | $1,000.00 | $2,630.27 |