- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $5,248.07 / $9,772.37
| Facility | | $870.96 | $5,248.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $676.08 / $1,548.82
| Professional | | $575.44 | $676.08 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $912.01 / $1,584.89
| Professional | | $616.60 | $912.01 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $933.25 / $6,760.83
| Professional | | $707.95 | $933.25 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $758.58 / $1,380.38
| Professional | | $588.84 | $758.58 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $707.95 / $831.76
| Professional | | $562.34 | $707.95 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $954.99 / $1,445.44
| Professional | | $758.58 | $954.99 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $794.33 / $1,202.26
| Facility | | $602.56 | $794.33 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $776.25 / $10,000.00
| Facility | | $575.44 | $776.25 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $776.25 / $10,000.00
| Professional | | $575.44 | $776.25 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $11,748.98 / $26,302.68
| Facility | | $7,413.10 | $11,748.98 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $741.31 / $1,202.26
| Professional | | $478.63 | $741.31 | $1,202.26 |