- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $3,019.95 / $10,715.19
| Facility | | $812.83 | $3,019.95 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $794.33 / $1,737.80
| Professional | | $549.54 | $794.33 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,019.95 / $7,943.28
| Facility | | $1,000.00 | $3,019.95 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $676.08 / $1,258.93
| Professional | | $501.19 | $676.08 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $1,288.25
| Facility | | $660.69 | $660.69 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $21,379.62
| Facility | | $1,047.13 | $1,047.13 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $776.25 / $1,380.38
| Professional | | $524.81 | $776.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $21,379.62
| Facility | | $1,047.13 | $1,047.13 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $794.33 / $1,348.96
| Professional | | $524.81 | $794.33 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $275.42
| Professional | | $32.36 | $33.11 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $776.25 / $2,951.21
| Facility | | $100.00 | $776.25 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $776.25 / $1,412.54
| Professional | | $501.19 | $776.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $4,265.80 / $7,413.10
| Facility | | $1,778.28 | $4,265.80 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $707.95 / $1,202.26
| Professional | | $478.63 | $707.95 | $1,202.26 |