- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $5,888.44 / $10,964.78
| Facility | | $1,584.89 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,230.27 / $6,456.54
| Professional | | $1,000.00 | $1,230.27 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,548.13 / $16,982.44
| Facility | | $2,238.72 | $3,548.13 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,023.29 / $1,778.28
| Professional | | $691.83 | $1,023.29 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,047.13 / $1,174.90
| Facility | | $977.24 | $1,047.13 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,000.00 / $21,379.62
| Facility | | $912.01 | $1,000.00 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,230.27 / $1,995.26
| Professional | | $338.84 | $1,230.27 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,258.93 / $1,995.26
| Professional | | $331.13 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $7,244.36
| Facility | | $100.00 | $100.00 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,230.27 / $2,344.23
| Professional | | $1,047.13 | $1,230.27 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,570.88 / $8,709.64
| Facility | | $2,818.38 | $4,570.88 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,071.52 / $1,819.70
| Professional | | $794.33 | $1,071.52 | $1,819.70 |