- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $4,786.30 / $8,317.64
| Facility | | $1,071.52 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,047.13 / $1,698.24
| Professional | | $870.96 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $6,165.95 / $57,543.99
| Facility | | $5,011.87 | $6,165.95 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,000.00 / $1,659.59
| Professional | | $954.99 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,047.13 / $1,698.24
| Professional | | $741.31 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,412.54
| Professional | | $1,023.29 | $1,023.29 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $912.01 / $1,513.56
| Professional | | $794.33 | $912.01 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $3,630.78 / $8,317.64
| Facility | | $831.76 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,047.13 / $1,737.80
| Professional | | $851.14 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $912.01 / $2,137.96
| Professional | | $870.96 | $912.01 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $954.99
| Facility | | $467.74 | $467.74 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $954.99
| Professional | | $467.74 | $467.74 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,890.45 / $7,585.78
| Facility | | $1,659.59 | $3,890.45 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,000.00 / $1,819.70
| Professional | | $741.31 | $1,000.00 | $1,819.70 |