- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $5,370.32 / $10,964.78
| Facility | | $707.95 | $5,370.32 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $588.84 / $1,548.82
| Professional | | $436.52 | $588.84 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,548.13 / $15,135.61
| Facility | | $1,698.24 | $3,548.13 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $549.54 / $851.14
| Professional | | $426.58 | $549.54 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $537.03
| Facility | | $457.09 | $457.09 | $537.03 |
- 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
- $416.87 / $645.65 / $954.99
| Professional | | $416.87 | $645.65 | $954.99 |
- 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
- $407.38 / $630.96 / $954.99
| Professional | | $407.38 | $630.96 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $67.61
| Professional | | $32.36 | $33.11 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $3,548.13
| Facility | | $100.00 | $100.00 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $537.03 / $1,023.29
| Professional | | $436.52 | $537.03 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $4,466.84 / $7,413.10
| Facility | | $2,187.76 | $4,466.84 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $537.03 / $851.14
| Professional | | $346.74 | $537.03 | $851.14 |