- 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
- $1,288.25 / $1,584.89 / $2,511.89
| Professional | | $1,288.25 | $1,584.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,659.59 / $2,187.76
| Professional | | $1,318.26 | $1,659.59 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,862.09 / $3,019.95
| Professional | | $1,445.44 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $8,912.51
| Facility | | $54.95 | $56.23 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $12,022.64 / $12,022.64
| Professional | | $10,471.29 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,995.26 / $4,365.16
| Facility | | $1,202.26 | $1,995.26 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,819.70 / $2,691.53
| Professional | | $1,412.54 | $1,819.70 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $194.98
| Professional | | $32.36 | $33.11 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $2,951.21 / $3,630.78
| Professional | | $18.20 | $2,951.21 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,905.46 / $3,162.28
| Facility | | $1,288.25 | $1,905.46 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,905.46 / $3,019.95
| Professional | | $1,412.54 | $1,905.46 | $3,019.95 |
- 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 / $1,584.89 / $2,454.71
| Professional | | $1,148.15 | $1,584.89 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,288.25 / $1,288.25
| Professional | | $1,202.26 | $1,288.25 | $1,288.25 |