- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,479.11 / $14,454.40
| Facility | | $707.95 | $1,479.11 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $724.44 / $1,778.28
| Professional | | $645.65 | $724.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,479.11 / $3,630.78
| Professional | | $707.95 | $1,479.11 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,238.72 / $3,548.13
| Facility | | $1,905.46 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $3,019.95 / $3,715.35
| Professional | | $891.25 | $3,019.95 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,479.11 / $5,754.40
| Facility | | $707.95 | $1,479.11 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,698.24 / $2,187.76
| Professional | | $1,288.25 | $1,698.24 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,479.11 / $11,481.54
| Facility | | $707.95 | $1,479.11 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,318.26 / $5,370.32
| Professional | | $707.95 | $1,318.26 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $8,511.38 / $9,120.11
| Facility | | $1,380.38 | $8,511.38 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,621.81 / $2,754.23
| Professional | | $891.25 | $1,621.81 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,659.59 / $2,454.71
| Professional | | $1,096.48 | $1,659.59 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $6,025.60 / $8,912.51
| Facility | | $3,235.94 | $6,025.60 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $3,311.31 / $5,370.32
| Professional | | $1,258.93 | $3,311.31 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,398.83
| Professional | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $4,073.80 / $4,570.88
| Professional | | $1,995.26 | $4,073.80 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $10,000.00 / $12,022.64
| Facility | | $6,309.57 | $10,000.00 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,096.48 / $2,818.38
| Professional | | $691.83 | $1,096.48 | $2,818.38 |