- 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
- $2,290.87 / $2,630.27 / $3,981.07
| Professional | | $2,290.87 | $2,630.27 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,691.53 / $3,630.78
| Professional | | $2,089.30 | $2,691.53 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,235.94 / $5,128.61
| Professional | | $2,398.83 | $3,235.94 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $14,454.40
| Facility | | $54.95 | $56.23 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30,902.95 / $30,902.95 / $33,113.11
| Professional | | $30,902.95 | $30,902.95 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,311.31 / $7,079.46
| Facility | | $1,778.28 | $3,311.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,090.30 / $4,786.30
| Professional | | $2,344.23 | $3,090.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,862.09
| Professional | | $32.36 | $33.11 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,162.28 / $6,456.54
| Facility | | $2,344.23 | $3,162.28 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,235.94 / $5,011.87
| Professional | | $2,398.83 | $3,235.94 | $5,011.87 |
- 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
- $1,995.26 / $2,630.27 / $4,073.80
| Professional | | $1,995.26 | $2,630.27 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $2,344.23
| Professional | | $2,137.96 | $2,137.96 | $2,344.23 |