- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $3,890.45 / $10,471.29
| Facility | | $562.34 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $537.03 / $1,348.96
| Professional | | $389.05 | $537.03 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,762.47 / $13,803.84
| Facility | | $4,073.80 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $407.38 / $1,047.13
| Professional | | $316.23 | $407.38 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,995.26 / $8,912.51
| Facility | | $549.54 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,862.09 / $53,703.18
| Facility | | $660.69 | $1,862.09 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 22 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $776.25 / $1,819.70
| Professional | | $398.11 | $776.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $851.14 / $1,412.54
| Facility | | $398.11 | $851.14 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $489.78 / $741.31
| Professional | | $363.08 | $489.78 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $524.81 / $812.83
| Professional | | $323.59 | $524.81 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $5,888.44 / $10,000.00
| Facility | | $4,265.80 | $5,888.44 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $50,118.72 / $75,857.76
| Facility | | $562.34 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $524.81 / $851.14
| Professional | | $398.11 | $524.81 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,981.07 / $9,772.37
| Facility | | $2,137.96 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $512.86 / $1,318.26
| Professional | | $316.23 | $512.86 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $501.19 / $1,778.28
| Facility | | $316.23 | $501.19 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $501.19 / $1,230.27
| Professional | | $316.23 | $501.19 | $1,230.27 |