- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $6,918.31 / $12,022.64
| Facility | | $912.01 | $6,918.31 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $645.65 / $7,413.10
| Professional | | $524.81 | $645.65 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,548.13 / $15,135.61
| Facility | | $1,698.24 | $3,548.13 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $630.96 / $1,096.48
| Professional | | $512.86 | $630.96 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $575.44 / $645.65
| Facility | | $537.03 | $575.44 | $645.65 |
- 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
- $204.17 / $741.31 / $1,122.02
| Professional | | $204.17 | $741.31 | $1,122.02 |
- 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
- $194.98 / $758.58 / $1,148.15
| Professional | | $194.98 | $758.58 | $1,148.15 |
- 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 / $4,365.16
| Facility | | $100.00 | $100.00 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $616.60 / $1,174.90
| Professional | | $537.03 | $616.60 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,265.80 / $8,128.31
| Facility | | $2,630.27 | $4,265.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $645.65 / $1,023.29
| Professional | | $478.63 | $645.65 | $1,023.29 |