- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $8,128.31 / $20,892.96
| Facility | | $1,513.56 | $8,128.31 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,023.29 / $2,041.74
| Professional | | $758.58 | $1,023.29 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,715.19 / $15,488.17 / $31,622.78
| Facility | | $10,715.19 | $15,488.17 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,548.82 / $2,187.76
| Professional | | $1,071.52 | $1,548.82 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,071.52 / $10,471.29
| Facility | | $891.25 | $1,071.52 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,412.54 / $2,398.83
| Professional | | $831.76 | $1,412.54 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,737.80 / $9,120.11
| Facility | | $1,000.00 | $1,737.80 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,659.59 / $6,918.31
| Professional | | $933.25 | $1,659.59 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $363.08
| Professional | | $32.36 | $33.11 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,584.89 / $1,819.70
| Facility | | $1,096.48 | $1,584.89 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,096.48 / $2,398.83
| Facility | | $1,071.52 | $1,096.48 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,621.81 / $2,089.30
| Professional | | $1,096.48 | $1,621.81 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,715.19 / $16,218.10 / $31,622.78
| Facility | | $10,715.19 | $16,218.10 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,548.82 / $2,137.96
| Professional | | $1,071.52 | $1,548.82 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $17,378.01 / $33,884.42
| Facility | | $3,467.37 | $17,378.01 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,288.25 / $2,137.96
| Professional | | $891.25 | $1,288.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $831.76 / $1,513.56
| Professional | | $794.33 | $831.76 | $1,513.56 |