- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $3,162.28 / $10,964.78
| Facility | | $912.01 | $3,162.28 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $794.33 / $1,949.84
| Professional | | $660.69 | $794.33 | $1,949.84 |
- 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
- $512.86 / $645.65 / $1,698.24
| Professional | | $512.86 | $645.65 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $37,153.52
| Facility | | $1,096.48 | $1,096.48 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $1,318.26 / $50,118.72
| Facility | | $34.67 | $1,318.26 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,096.48 / $3,630.78
| Professional | | $691.83 | $1,096.48 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,000.00 / $2,818.38
| Facility | | $776.25 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,174.90 / $1,659.59
| Professional | | $776.25 | $1,174.90 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,000.00 / $1,659.59
| Professional | | $562.34 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $50,118.72 / $75,857.76
| Facility | | $676.08 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,096.48 / $1,584.89
| Professional | | $398.11 | $1,096.48 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $4,073.80 / $9,120.11
| Facility | | $1,479.11 | $4,073.80 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,148.15 / $3,981.07
| Professional | | $691.83 | $1,148.15 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $912.01 / $3,019.95
| Facility | | $630.96 | $912.01 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $954.99 / $2,089.30
| Professional | | $602.56 | $954.99 | $2,089.30 |