- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $8,317.64 / $17,378.01
| Facility | | $1,318.26 | $8,317.64 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,288.25 / $2,570.40
| Professional | | $1,023.29 | $1,288.25 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15,848.93 / $36,307.81 / $47,863.01
| Facility | | $15,848.93 | $36,307.81 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,318.26 / $1,862.09
| Professional | | $1,000.00 | $1,318.26 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,230.27 / $1,905.46
| Professional | | $1,122.02 | $1,230.27 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,412.54 / $2,041.74
| Professional | | $1,047.13 | $1,412.54 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,047.13 / $1,318.26
| Professional | | $870.96 | $1,047.13 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Professional | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,380.38 / $2,398.83
| Facility | | $1,000.00 | $1,380.38 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,445.44 / $10,000.00
| Facility | | $977.24 | $1,445.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,445.44 / $10,000.00
| Professional | | $977.24 | $1,445.44 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,311.31 / $6,309.57
| Facility | | $1,584.89 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,548.82 / $2,454.71
| Professional | | $977.24 | $1,548.82 | $2,454.71 |