- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $3,019.95 / $7,413.10
| Facility | | $794.33 | $3,019.95 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $616.60 / $1,047.13
| Professional | | $524.81 | $616.60 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,365.16 / $8,317.64
| Facility | | $2,570.40 | $4,365.16 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $691.83 / $933.25
| Professional | | $549.54 | $691.83 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $549.54 / $549.54
| Facility | | $79.43 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $776.25 / $1,230.27
| Professional | | $562.34 | $776.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $28,840.32 / $28,840.32
| Facility | | $11,748.98 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $6,606.93
| Professional | | $5,128.61 | $5,128.61 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $912.01 / $3,890.45
| Facility | | $588.84 | $912.01 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $1,288.25
| Professional | | $537.03 | $776.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $549.54
| Professional | | $32.36 | $33.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Professional | | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $794.33 / $1,288.25
| Facility | | $562.34 | $794.33 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $776.25 / $1,230.27
| Professional | | $549.54 | $776.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $4,786.30 / $9,120.11
| Facility | | $1,737.80 | $4,786.30 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $630.96 / $977.24
| Professional | | $467.74 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $549.54 / $575.44
| Professional | | $537.03 | $549.54 | $575.44 |