- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,715.35 / $12,882.50
| Facility | | $1,000.00 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,398.83 / $3,467.37
| Professional | | $1,949.84 | $2,398.83 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,041.74 / $2,630.27
| Professional | | $1,905.46 | $2,041.74 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,754.23 / $4,466.84
| Professional | | $2,041.74 | $2,754.23 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $13,182.57
| Facility | | $54.95 | $56.23 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15,135.61 / $17,378.01 / $17,378.01
| Professional | | $15,135.61 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,511.89 / $5,248.07
| Facility | | $1,737.80 | $2,511.89 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,818.38 / $3,981.07
| Professional | | $2,041.74 | $2,818.38 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $281.84
| Professional | | $32.36 | $33.11 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $4,265.80 / $5,370.32
| Professional | | $6.03 | $4,265.80 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,511.89 / $4,677.35
| Facility | | $1,862.09 | $2,511.89 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,754.23 / $4,466.84
| Professional | | $2,041.74 | $2,754.23 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,344.23 / $8,912.51
| Facility | | $446.68 | $2,344.23 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,290.87 / $3,630.78
| Professional | | $1,698.24 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,905.46 / $1,905.46
| Professional | | $1,778.28 | $1,905.46 | $1,905.46 |