- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $4,073.80 / $13,489.63
| Facility | | $1,096.48 | $4,073.80 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,096.48 / $1,862.09
| Professional | | $933.25 | $1,096.48 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,365.16 / $8,317.64
| Facility | | $2,344.23 | $4,365.16 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,230.27 / $1,621.81
| Professional | | $954.99 | $1,230.27 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $954.99 / $954.99
| Facility | | $79.43 | $954.99 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,348.96 / $2,089.30
| Professional | | $912.01 | $1,348.96 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $42,657.95 / $42,657.95
| Facility | | $9,332.54 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $9,120.11 / $9,120.11
| Professional | | $7,585.78 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,380.38 / $5,248.07
| Facility | | $954.99 | $1,380.38 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,348.96 / $2,238.72
| Professional | | $954.99 | $1,348.96 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $134.90 / $891.25
| Professional | | $32.36 | $134.90 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $3,467.37 / $3,630.78
| Professional | | $851.14 | $3,467.37 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,230.27 / $2,187.76
| Facility | | $954.99 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,348.96 / $2,089.30
| Professional | | $933.25 | $1,348.96 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,290.87 / $4,570.88
| Facility | | $776.25 | $2,290.87 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,071.52 / $1,659.59
| Professional | | $794.33 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $954.99 / $1,000.00
| Professional | | $933.25 | $954.99 | $1,000.00 |