- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $7,413.10 / $12,022.64
| Facility | | $1,905.46 | $7,413.10 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,584.89 / $4,570.88
| Professional | | $1,258.93 | $1,584.89 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,365.16 / $16,982.44
| Facility | | $2,238.72 | $4,365.16 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,698.24 / $3,162.28
| Professional | | $1,230.27 | $1,698.24 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,548.82
| Facility | | $1,318.26 | $1,318.26 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,238.72 / $21,379.62
| Facility | | $1,513.56 | $2,238.72 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,778.28 / $2,691.53
| Professional | | $1,202.26 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,778.28 / $2,691.53
| Professional | | $1,202.26 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $234.42
| Professional | | $32.36 | $33.11 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $7,244.36
| Facility | | $100.00 | $100.00 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,479.11 / $2,818.38
| Professional | | $1,202.26 | $1,479.11 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $6,606.93 / $13,489.63
| Facility | | $4,265.80 | $6,606.93 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,513.56 / $2,398.83
| Professional | | $1,000.00 | $1,513.56 | $2,398.83 |