- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $5,128.61 / $11,220.18
| Facility | | $1,258.93 | $5,128.61 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,258.93 / $2,511.89
| Professional | | $1,096.48 | $1,258.93 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $10,000.00 / $57,543.99
| Facility | | $8,511.38 | $10,000.00 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,318.26 / $2,238.72
| Professional | | $1,230.27 | $1,318.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,445.44 / $2,454.71
| Professional | | $1,023.29 | $1,445.44 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,819.70 / $2,344.23
| Professional | | $1,348.96 | $1,819.70 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,479.11 / $2,089.30
| Professional | | $1,122.02 | $1,479.11 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $20,417.38 / $35,481.34
| Facility | | $6,165.95 | $20,417.38 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,659.59 / $1,737.80
| Professional | | $1,479.11 | $1,659.59 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $3,801.89 / $10,000.00
| Facility | | $1,047.13 | $3,801.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,412.54 / $2,818.38
| Professional | | $1,122.02 | $1,412.54 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,778.28 / $2,630.27
| Professional | | $1,348.96 | $1,778.28 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $1,621.81
| Facility | | $478.63 | $478.63 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,148.15 / $1,258.93
| Professional | | $478.63 | $1,148.15 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $6,309.57 / $40,738.03
| Facility | | $3,019.95 | $6,309.57 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,412.54 / $2,570.40
| Professional | | $1,023.29 | $1,412.54 | $2,570.40 |