- 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
- $1,258.93 / $1,548.82 / $2,344.23
| Professional | | $1,258.93 | $1,548.82 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,548.82 / $2,137.96
| Professional | | $1,230.27 | $1,548.82 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,819.70 / $2,818.38
| Professional | | $1,380.38 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $8,317.64
| Facility | | $54.95 | $56.23 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $11,748.98 / $11,748.98
| Professional | | $9,772.37 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,905.46 / $4,466.84
| Facility | | $1,258.93 | $1,905.46 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,905.46 / $2,570.40
| Professional | | $1,318.26 | $1,905.46 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $181.97
| Professional | | $32.36 | $33.11 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $2,691.53 / $3,388.44
| Professional | | $18.20 | $2,691.53 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,819.70 / $3,019.95
| Facility | | $1,318.26 | $1,819.70 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,819.70 / $2,818.38
| Professional | | $1,348.96 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,290.87 / $8,912.51
| Facility | | $446.68 | $2,290.87 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,548.82 / $2,398.83
| Professional | | $1,148.15 | $1,548.82 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,380.38 / $1,380.38
| Professional | | $1,258.93 | $1,380.38 | $1,380.38 |