- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $3,090.30 / $7,762.47
| Facility | | $363.08 | $3,090.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $512.86 / $1,348.96
| Professional | | $229.09 | $512.86 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $218.78
| Professional | | $213.80 | $213.80 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $9,772.37
| Facility | | $2,630.27 | $4,786.30 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $630.96 / $1,348.96
| Professional | | $537.03 | $630.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $6,165.95
| Facility | | $331.13 | $331.13 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $1,202.26
| Professional | | $331.13 | $331.13 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $398.11 / $50,118.72
| Facility | | $34.67 | $398.11 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $812.83 / $2,398.83
| Professional | | $263.03 | $812.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $316.23 / $794.33
| Facility | | $223.87 | $316.23 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,348.96 / $1,995.26
| Professional | | $1,047.13 | $1,348.96 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,000.00 / $1,698.24
| Professional | | $562.34 | $1,000.00 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,148.15 / $1,202.26
| Facility | | $831.76 | $1,148.15 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $50,118.72 / $75,857.76
| Facility | | $275.42 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,096.48 / $2,137.96
| Professional | | $912.01 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,467.37 / $7,244.36
| Facility | | $1,659.59 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,148.15 / $3,235.94
| Professional | | $269.15 | $1,148.15 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $338.84 / $588.84
| Facility | | $190.55 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $912.01 / $1,621.81
| Professional | | $467.74 | $912.01 | $1,621.81 |