- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,698.24 / $8,709.64
| Facility | | $1,047.13 | $1,698.24 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,174.90 / $2,238.72
| Professional | | $1,000.00 | $1,174.90 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,778.28 / $3,019.95
| Professional | | $1,122.02 | $1,778.28 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $512.86 / $35,481.34
| Facility | | $323.59 | $512.86 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,479.11 / $2,630.27
| Professional | | $1,023.29 | $1,479.11 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $1,659.59
| Professional | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,318.26 / $2,089.30
| Facility | | $1,023.29 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $2,818.38
| Professional | | $1,202.26 | $1,202.26 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,071.52 / $1,071.52
| Professional | | $1,023.29 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $2,511.89 / $6,309.57
| Facility | | $323.59 | $2,511.89 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,174.90 / $2,089.30
| Professional | | $891.25 | $1,174.90 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $6,606.93 / $6,606.93
| Facility | | $56.23 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $9,120.11
| Professional | | $7,413.10 | $7,413.10 | $9,120.11 |