- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $7,079.46 / $16,595.87
| Facility | | $912.01 | $7,079.46 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $851.14 / $1,513.56
| Professional | | $691.83 | $851.14 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $18,620.87 / $25,118.86
| Facility | | $11,220.18 | $18,620.87 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,000.00 / $1,548.82
| Professional | | $741.31 | $1,000.00 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $851.14 / $1,513.56
| Professional | | $758.58 | $851.14 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $524.81 / $1,318.26
| Facility | | $489.78 | $524.81 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $933.25 / $1,479.11
| Professional | | $645.65 | $933.25 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $851.14 / $1,412.54
| Professional | | $707.95 | $851.14 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,096.48 / $1,819.70
| Professional | | $1,023.29 | $1,096.48 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,023.29 / $1,584.89
| Facility | | $758.58 | $1,023.29 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,621.81
| Professional | | $1,071.52 | $1,071.52 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $933.25 / $2,187.76
| Facility | | $741.31 | $933.25 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $933.25 / $2,187.76
| Professional | | $741.31 | $933.25 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $3,162.28 / $5,754.40
| Facility | | $512.86 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $891.25 / $1,513.56
| Professional | | $616.60 | $891.25 | $1,513.56 |