- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $8,511.38 / $20,892.96
| Facility | | $3,019.95 | $8,511.38 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $346.74 / $457.09
| Professional | | $275.42 | $346.74 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $8,709.64 / $17,378.01
| Facility | | $7,079.46 | $8,709.64 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $660.69 / $977.24
| Professional | | $489.78 | $660.69 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $870.96 / $6,456.54
| Facility | | $707.95 | $870.96 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $10,471.29 / $14,454.40
| Facility | | $2,884.03 | $10,471.29 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,258.93 / $1,258.93
| Professional | | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $60.26
| Professional | | $50.12 | $50.12 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $426.58 / $3,388.44
| Facility | | $354.81 | $426.58 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $512.86 / $1,288.25
| Facility | | $478.63 | $512.86 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $707.95 / $933.25
| Professional | | $512.86 | $707.95 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $8,912.51 / $17,378.01
| Facility | | $6,606.93 | $8,912.51 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $645.65 / $912.01
| Professional | | $489.78 | $645.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $10,232.93 / $18,620.87
| Facility | | $2,884.03 | $10,232.93 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $549.54 / $933.25
| Professional | | $416.87 | $549.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $537.03 / $1,000.00
| Professional | | $524.81 | $537.03 | $1,000.00 |