- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,548.82 / $20,892.96
| Facility | | $1,148.15 | $1,548.82 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $660.69 / $1,513.56
| Professional | | $537.03 | $660.69 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,148.15 / $1,548.82
| Professional | | $870.96 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $707.95 / $1,047.13
| Facility | | $501.19 | $707.95 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $954.99 / $1,862.09
| Professional | | $549.54 | $954.99 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,000.00 / $1,513.56
| Facility | | $588.84 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $912.01 / $1,479.11
| Professional | | $575.44 | $912.01 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $275.42
| Professional | | $32.36 | $33.11 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,174.90 / $1,230.27
| Facility | | $707.95 | $1,174.90 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $851.14
| Facility | | $831.76 | $831.76 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,202.26 / $1,778.28
| Professional | | $851.14 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,174.90 / $1,479.11
| Professional | | $891.25 | $1,174.90 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,047.13 / $3,715.35
| Facility | | $645.65 | $1,047.13 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $851.14 / $1,584.89
| Professional | | $616.60 | $851.14 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $676.08 / $1,202.26
| Professional | | $588.84 | $676.08 | $1,202.26 |