- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $6,918.31 / $12,022.64
| Facility | | $1,258.93 | $6,918.31 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $912.01 / $2,398.83
| Professional | | $758.58 | $912.01 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $3,715.35 / $12,882.50
| Facility | | $1,071.52 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $933.25 / $1,513.56
| Professional | | $741.31 | $933.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $870.96 / $3,630.78
| Facility | | $758.58 | $870.96 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $954.99
| Professional | | $851.14 | $851.14 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,380.38 / $4,897.79
| Facility | | $691.83 | $1,380.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,071.52 / $1,778.28
| Professional | | $588.84 | $1,071.52 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,380.38 / $5,888.44
| Facility | | $691.83 | $1,380.38 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,047.13 / $1,659.59
| Professional | | $457.09 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $117.49
| Professional | | $32.36 | $33.11 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $7,244.36
| Facility | | $100.00 | $100.00 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $851.14 / $1,621.81
| Professional | | $724.44 | $851.14 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $6,025.60 / $13,489.63
| Facility | | $1,047.13 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $912.01 / $1,479.11
| Professional | | $660.69 | $912.01 | $1,479.11 |