- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $5,128.61 / $14,791.08
| Facility | | $812.83 | $5,128.61 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $794.33 / $3,019.95
| Professional | | $269.15 | $794.33 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $1,122.02
| Professional | | $45.71 | $79.43 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $8,912.51 / $17,378.01
| Facility | | $6,456.54 | $8,912.51 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,174.90 / $1,659.59
| Professional | | $812.83 | $1,174.90 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $870.96 / $4,466.84
| Facility | | $707.95 | $870.96 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,000.00 / $1,819.70
| Professional | | $588.84 | $1,000.00 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,258.93 / $3,890.45
| Facility | | $676.08 | $1,258.93 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,202.26 / $2,951.21
| Professional | | $630.96 | $1,202.26 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $269.15
| Professional | | $32.36 | $33.11 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,174.90 / $1,202.26
| Facility | | $776.25 | $1,174.90 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $831.76 / $977.24
| Facility | | $794.33 | $831.76 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,202.26 / $1,584.89
| Professional | | $831.76 | $1,202.26 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $9,120.11 / $17,378.01
| Facility | | $6,760.83 | $9,120.11 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,174.90 / $1,621.81
| Professional | | $812.83 | $1,174.90 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $10,471.29 / $19,498.45
| Facility | | $3,019.95 | $10,471.29 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $912.01 / $1,659.59
| Professional | | $630.96 | $912.01 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $645.65 / $1,174.90
| Professional | | $616.60 | $645.65 | $1,174.90 |