- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $8,128.31 / $20,892.96
| Facility | | $1,621.81 | $8,128.31 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,122.02 / $2,187.76
| Professional | | $758.58 | $1,122.02 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $19,054.61 / $38,904.51
| Facility | | $6,456.54 | $19,054.61 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,659.59 / $2,238.72
| Professional | | $1,174.90 | $1,659.59 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,071.52 / $10,000.00
| Facility | | $891.25 | $1,071.52 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,412.54 / $2,454.71
| Professional | | $812.83 | $1,412.54 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,698.24 / $8,128.31
| Facility | | $891.25 | $1,698.24 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,621.81 / $6,606.93
| Professional | | $794.33 | $1,621.81 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $104.71
| Professional | | $32.36 | $33.11 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,548.82 / $1,698.24
| Facility | | $1,071.52 | $1,548.82 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $2,187.76
| Facility | | $1,148.15 | $1,148.15 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,659.59 / $2,238.72
| Professional | | $1,148.15 | $1,659.59 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,182.57 / $19,952.62 / $38,904.51
| Facility | | $13,182.57 | $19,952.62 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,659.59 / $2,238.72
| Professional | | $1,174.90 | $1,659.59 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $20,892.96 / $41,686.94
| Facility | | $2,951.21 | $20,892.96 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,174.90 / $2,187.76
| Professional | | $812.83 | $1,174.90 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $954.99 / $1,737.80
| Professional | | $912.01 | $954.99 | $1,737.80 |