- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $4,168.69 / $12,589.25
| Facility | | $1,202.26 | $4,168.69 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,000.00 / $1,778.28
| Professional | | $831.76 | $1,000.00 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,344.23 / $5,011.87
| Facility | | $1,348.96 | $2,344.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,096.48 / $1,445.44
| Professional | | $851.14 | $1,096.48 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,318.26 / $1,737.80
| Professional | | $870.96 | $1,318.26 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $831.76 / $851.14
| Facility | | $79.43 | $831.76 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,230.27 / $1,949.84
| Professional | | $870.96 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $33,884.42 / $33,884.42
| Facility | | $5,754.40 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $8,128.31 / $8,128.31
| Professional | | $6,760.83 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,380.38 / $6,456.54
| Facility | | $891.25 | $1,380.38 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,202.26 / $2,137.96
| Professional | | $851.14 | $1,202.26 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $120.23 / $794.33
| Professional | | $32.36 | $120.23 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $3,162.28 / $3,311.31
| Professional | | $1,230.27 | $3,162.28 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,202.26 / $1,995.26
| Facility | | $870.96 | $1,202.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,230.27 / $1,905.46
| Professional | | $851.14 | $1,230.27 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $5,888.44 / $11,481.54
| Facility | | $1,479.11 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,000.00 / $1,548.82
| Professional | | $741.31 | $1,000.00 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $851.14 / $891.25
| Professional | | $831.76 | $851.14 | $891.25 |