- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $3,467.37 / $8,912.51
| Facility | | $660.69 | $3,467.37 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $575.44 / $1,479.11
| Professional | | $457.09 | $575.44 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,495.41 / $12,882.50
| Facility | | $3,388.44 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $436.52 / $1,202.26
| Professional | | $338.84 | $436.52 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,698.24 / $6,165.95
| Facility | | $660.69 | $1,698.24 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,819.70 / $53,703.18
| Facility | | $794.33 | $1,819.70 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Facility | 22 | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $831.76 / $2,137.96
| Professional | | $407.38 | $831.76 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $812.83 / $1,584.89
| Facility | | $478.63 | $812.83 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $588.84 / $870.96
| Professional | | $436.52 | $588.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $630.96 / $1,000.00
| Professional | | $371.54 | $630.96 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $5,248.07 / $8,912.51
| Facility | | $3,801.89 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $50,118.72 / $75,857.76
| Facility | | $537.03 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $630.96 / $1,023.29
| Professional | | $398.11 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,981.07 / $9,120.11
| Facility | | $2,137.96 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $616.60 / $1,548.82
| Professional | | $371.54 | $616.60 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $602.56 / $1,698.24
| Facility | | $380.19 | $602.56 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $616.60 / $1,513.56
| Professional | | $380.19 | $616.60 | $1,513.56 |