- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $2,290.87 / $6,456.54
| Facility | | $512.86 | $2,290.87 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $269.15 / $977.24
| Professional | | $123.03 | $269.15 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $151.36 / $234.42
| Professional | | $112.20 | $151.36 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,754.23 / $7,943.28
| Facility | | $1,000.00 | $2,754.23 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $186.21 / $588.84
| Professional | | $131.83 | $186.21 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $125.89 / $141.25
| Facility | | $117.49 | $125.89 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $380.19 / $891.25
| Professional | | $141.25 | $380.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,819.70 / $4,168.69
| Facility | | $1,318.26 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $371.54 / $891.25
| Professional | | $141.25 | $371.54 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $2,041.74
| Facility | | $100.00 | $100.00 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $478.63 / $870.96
| Professional | | $114.82 | $478.63 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,570.40 / $5,248.07
| Facility | | $1,230.27 | $2,570.40 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $245.47 / $831.76
| Professional | | $125.89 | $245.47 | $831.76 |