- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $6,025.60 / $18,620.87
| Facility | | $1,412.54 | $6,025.60 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $954.99 / $1,862.09
| Professional | | $660.69 | $954.99 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $8,912.51 / $17,378.01
| Facility | | $5,495.41 | $8,912.51 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,445.44 / $2,041.74
| Professional | | $1,000.00 | $1,445.44 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $758.58 / $3,981.07
| Facility | | $630.96 | $758.58 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,230.27 / $2,238.72
| Professional | | $707.95 | $1,230.27 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,513.56 / $3,467.37
| Facility | | $812.83 | $1,513.56 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,513.56 / $2,630.27
| Professional | | $741.31 | $1,513.56 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $338.84
| Professional | | $32.36 | $33.11 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,445.44 / $1,479.11
| Facility | | $977.24 | $1,445.44 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,023.29
| Facility | | $1,000.00 | $1,000.00 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,479.11 / $1,949.84
| Professional | | $1,023.29 | $1,479.11 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $9,120.11 / $17,378.01
| Facility | | $6,606.93 | $9,120.11 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,445.44 / $1,995.26
| Professional | | $1,000.00 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $10,232.93 / $19,054.61
| Facility | | $2,137.96 | $10,232.93 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,071.52 / $1,949.84
| Professional | | $758.58 | $1,071.52 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $776.25 / $1,412.54
| Professional | | $741.31 | $776.25 | $1,412.54 |