- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $4,786.30 / $19,952.62
| Facility | | $933.25 | $4,786.30 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $724.44 / $2,754.23
| Professional | | $416.87 | $724.44 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $6,165.95 / $12,589.25
| Facility | | $4,466.84 | $6,165.95 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,202.26 / $1,698.24
| Professional | | $870.96 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $2,454.71
| Facility | | $1,023.29 | $1,023.29 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,000.00 / $1,905.46
| Professional | | $549.54 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,122.02 / $2,137.96
| Facility | | $602.56 | $1,122.02 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,122.02 / $1,737.80
| Professional | | $602.56 | $1,122.02 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $416.87
| Professional | | $32.36 | $33.11 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,258.93 / $1,348.96
| Facility | | $758.58 | $1,258.93 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $912.01
| Facility | | $891.25 | $891.25 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,071.52 / $1,659.59
| Professional | | $645.65 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $6,456.54 / $12,589.25
| Facility | | $4,365.16 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,258.93 / $1,698.24
| Professional | | $912.01 | $1,258.93 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $6,918.31 / $13,182.57
| Facility | | $1,288.25 | $6,918.31 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $870.96 / $1,548.82
| Professional | | $588.84 | $870.96 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $794.33 / $1,479.11
| Professional | | $89.13 | $794.33 | $1,479.11 |