- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $3,715.35 / $10,715.19
| Facility | | $537.03 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $323.59 / $831.76
| Professional | | $269.15 | $323.59 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,630.27 / $5,888.44
| Facility | | $954.99 | $2,630.27 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $346.74 / $549.54
| Professional | | $269.15 | $346.74 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $295.12 / $1,096.48
| Facility | | $263.03 | $295.12 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $331.13
| Professional | | $295.12 | $295.12 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $602.56 / $1,445.44
| Facility | | $478.63 | $602.56 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $380.19 / $645.65
| Professional | | $275.42 | $380.19 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $616.60 / $1,778.28
| Facility | | $478.63 | $616.60 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $371.54 / $616.60
| Professional | | $263.03 | $371.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $52.48
| Professional | | $32.36 | $33.11 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $2,344.23
| Facility | | $100.00 | $100.00 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $302.00 / $562.34
| Professional | | $257.04 | $302.00 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,290.87 / $5,248.07
| Facility | | $724.44 | $2,290.87 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $323.59 / $512.86
| Professional | | $229.09 | $323.59 | $512.86 |