- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $2,238.72 / $10,232.93
| Facility | | $537.03 | $2,238.72 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $588.84 / $1,071.52
| Professional | | $302.00 | $588.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,019.95 / $9,772.37
| Facility | | $1,000.00 | $3,019.95 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $371.54 / $575.44
| Professional | | $281.84 | $371.54 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $380.19
| Facility | | $316.23 | $316.23 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $21,379.62
| Facility | | $524.81 | $524.81 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $630.96 / $1,096.48
| Professional | | $338.84 | $630.96 | $1,096.48 |
- 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
- $331.13 / $616.60 / $1,071.52
| Professional | | $331.13 | $616.60 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $2,398.83
| Facility | | $100.00 | $100.00 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $724.44 / $1,096.48
| Professional | | $316.23 | $724.44 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $4,265.80 / $7,244.36
| Facility | | $1,479.11 | $4,265.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $512.86 / $933.25
| Professional | | $275.42 | $512.86 | $933.25 |