- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,071.52 / $6,456.54
| Facility | | $630.96 | $1,071.52 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $691.83 / $1,348.96
| Professional | | $512.86 | $691.83 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $10,964.78 / $18,197.01
| Facility | | $6,606.93 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,000.00 / $2,398.83
| Professional | | $645.65 | $1,000.00 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,995.26 / $3,235.94
| Facility | | $1,737.80 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,412.54 / $2,290.87
| Professional | | $630.96 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,412.54 / $5,754.40
| Facility | | $630.96 | $1,412.54 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,445.44 / $1,905.46
| Professional | | $1,122.02 | $1,445.44 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $4,677.35 / $15,135.61
| Facility | | $630.96 | $4,677.35 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,258.93 / $3,981.07
| Professional | | $660.69 | $1,258.93 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $933.25
| Professional | | $32.36 | $33.11 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $9,332.54 / $15,848.93
| Facility | | $1,071.52 | $9,332.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,698.24 / $2,290.87
| Professional | | $891.25 | $1,698.24 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,548.82 / $2,238.72
| Professional | | $776.25 | $1,548.82 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $16,595.87 / $16,595.87
| Facility | | $11,220.18 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,995.26 / $4,677.35
| Professional | | $707.95 | $1,995.26 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,258.93 / $1,584.89
| Professional | | $1,258.93 | $1,258.93 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,090.30 / $3,890.45
| Professional | | $1,659.59 | $3,090.30 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $12,022.64 / $15,848.93
| Facility | | $7,585.78 | $12,022.64 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,000.00 / $2,570.40
| Professional | | $562.34 | $1,000.00 | $2,570.40 |