- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $3,715.35 / $6,456.54
| Facility | | $562.34 | $3,715.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $446.68 / $1,202.26
| Professional | | $190.55 | $446.68 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $630.96 / $1,949.84
| Professional | | $257.04 | $630.96 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $239.88 / $338.84
| Facility | | $177.83 | $239.88 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $436.52 / $660.69
| Professional | | $426.58 | $436.52 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,548.82 / $2,454.71
| Facility | | $1,318.26 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Facility | 22 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $707.95 / $2,089.30
| Professional | | $239.88 | $707.95 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $501.19 / $3,311.31
| Facility | | $194.98 | $501.19 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $724.44 / $1,288.25
| Professional | | $354.81 | $724.44 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $562.34 / $4,265.80
| Facility | | $199.53 | $562.34 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,000.00 / $3,630.78
| Professional | | $281.84 | $1,000.00 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $3,890.45 / $4,570.88
| Facility | | $436.52 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $707.95 / $1,698.24
| Professional | | $436.52 | $707.95 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $741.31 / $1,778.28
| Professional | | $309.03 | $741.31 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $4,897.79 / $4,897.79
| Facility | | $331.13 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Facility | 22 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,047.13 / $3,467.37
| Professional | | $257.04 | $1,047.13 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $1,905.46
| Professional | | $707.95 | $707.95 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $977.24 / $2,511.89
| Professional | | $707.95 | $977.24 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,548.13 / $6,760.83
| Facility | | $2,754.23 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $489.78 / $1,584.89
| Professional | | $208.93 | $489.78 | $1,584.89 |