- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $8,912.51 / $11,748.98
| Facility | | $776.25 | $8,912.51 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $758.58 / $1,445.44
| Professional | | $630.96 | $758.58 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $6,456.54 / $15,135.61
| Facility | | $1,698.24 | $6,456.54 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $741.31 / $1,174.90
| Professional | | $602.56 | $741.31 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $676.08 / $870.96
| Facility | | $660.69 | $676.08 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $831.76
| Professional | | $741.31 | $741.31 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,174.90 / $1,202.26
| Facility | | $524.81 | $1,174.90 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $891.25 / $1,513.56
| Professional | | $562.34 | $891.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $602.56 / $1,202.26
| Facility | | $34.67 | $602.56 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $891.25 / $1,412.54
| Professional | | $537.03 | $891.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $794.33 / $1,513.56
| Professional | | $676.08 | $794.33 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,884.03 / $5,754.40
| Facility | | $575.44 | $2,884.03 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $758.58 / $1,258.93
| Professional | | $549.54 | $758.58 | $1,258.93 |