- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $7,943.28 / $20,892.96
| Facility | | $1,148.15 | $7,943.28 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $776.25 / $1,513.56
| Professional | | $512.86 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $4,897.79 / $10,000.00
| Facility | | $3,548.13 | $4,897.79 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,174.90 / $1,659.59
| Professional | | $831.76 | $1,174.90 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $870.96 / $2,818.38
| Facility | | $707.95 | $870.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,000.00 / $1,778.28
| Professional | | $575.44 | $1,000.00 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,230.27 / $2,691.53
| Facility | | $630.96 | $1,230.27 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,174.90 / $2,041.74
| Professional | | $575.44 | $1,174.90 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $275.42
| Professional | | $32.36 | $33.11 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,148.15 / $1,230.27
| Facility | | $691.83 | $1,148.15 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $831.76
| Facility | | $812.83 | $812.83 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,230.27 / $1,584.89
| Professional | | $831.76 | $1,230.27 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,011.87 / $10,000.00
| Facility | | $3,388.44 | $5,011.87 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,174.90 / $1,659.59
| Professional | | $831.76 | $1,174.90 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $6,456.54 / $11,748.98
| Facility | | $1,380.38 | $6,456.54 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $851.14 / $1,548.82
| Professional | | $602.56 | $851.14 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $660.69 / $1,202.26
| Professional | | $630.96 | $660.69 | $1,202.26 |