- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,818.38 / $10,715.19
| Facility | | $676.08 | $2,818.38 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $501.19 / $1,445.44
| Professional | | $416.87 | $501.19 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,398.83 / $5,888.44
| Facility | | $954.99 | $2,398.83 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $501.19 / $794.33
| Professional | | $389.05 | $501.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $478.63 / $1,737.80
| Facility | | $416.87 | $478.63 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $524.81
| Professional | | $457.09 | $457.09 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $741.31 / $2,398.83
| Facility | | $380.19 | $741.31 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $537.03 / $954.99
| Professional | | $346.74 | $537.03 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $741.31 / $2,818.38
| Facility | | $380.19 | $741.31 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $537.03 / $870.96
| Professional | | $346.74 | $537.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $53.70
| Professional | | $32.36 | $33.11 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $4,073.80
| Facility | | $100.00 | $100.00 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $501.19 / $933.25
| Professional | | $426.58 | $501.19 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,570.40 / $6,606.93
| Facility | | $724.44 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $478.63 / $776.25
| Professional | | $338.84 | $478.63 | $776.25 |