- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $10,000.00 / $20,892.96
| Facility | | $3,801.89 | $10,000.00 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,513.56 / $7,585.78
| Professional | | $1,258.93 | $1,513.56 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $11,220.18 / $17,782.79
| Facility | | $6,456.54 | $11,220.18 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,089.30 / $4,168.69
| Professional | | $1,584.89 | $2,089.30 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $5,623.41 / $10,715.19
| Facility | | $83.18 | $5,623.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,862.09 / $3,801.89
| Professional | | $1,318.26 | $1,862.09 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,737.80 / $3,630.78
| Professional | | $1,288.25 | $1,737.80 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,584.89 / $6,456.54
| Professional | | $1,412.54 | $1,584.89 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,584.89 / $3,090.30
| Professional | | $1,174.90 | $1,584.89 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $26,302.68
| Facility | | $54.95 | $56.23 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $12,022.64 / $12,022.64
| Professional | | $11,220.18 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,041.74
| Professional | | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,737.80 / $2,818.38
| Facility | | $1,318.26 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,778.28 / $3,630.78
| Professional | | $1,288.25 | $1,778.28 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $4,570.88 / $4,570.88
| Professional | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,288.25 / $1,584.89
| Professional | | $1,148.15 | $1,288.25 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $14,125.38 / $28,840.32
| Facility | | $7,762.47 | $14,125.38 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,479.11 / $3,235.94
| Professional | | $1,096.48 | $1,479.11 | $3,235.94 |