- 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
- $2,691.53 / $3,090.30 / $4,677.35
| Professional | | $2,691.53 | $3,090.30 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,090.30 / $4,265.80
| Professional | | $2,454.71 | $3,090.30 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,630.78 / $5,888.44
| Professional | | $2,818.38 | $3,630.78 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $16,595.87
| Facility | | $54.95 | $56.23 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26,915.35 / $26,915.35 / $28,183.83
| Professional | | $26,915.35 | $26,915.35 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,715.35 / $7,413.10
| Facility | | $1,778.28 | $3,715.35 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,715.35 / $5,623.41
| Professional | | $2,691.53 | $3,715.35 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $2,137.96
| Professional | | $32.36 | $33.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,715.35 / $6,309.57
| Facility | | $2,754.23 | $3,715.35 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,630.78 / $5,623.41
| Professional | | $2,754.23 | $3,630.78 | $5,623.41 |
- 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
- $2,290.87 / $3,019.95 / $4,786.30
| Professional | | $2,290.87 | $3,019.95 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,754.23
| Professional | | $2,511.89 | $2,511.89 | $2,754.23 |