- 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
- $2,041.74 / $2,398.83 / $3,630.78
| Professional | | $2,041.74 | $2,398.83 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,454.71 / $3,467.37
| Professional | | $1,949.84 | $2,454.71 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,238.72
| Facility | | $2,041.74 | $2,041.74 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $891.25 / $3,801.89
| Facility | | $537.03 | $891.25 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,818.38 / $4,677.35
| Professional | | $1,737.80 | $2,818.38 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $13,803.84
| Facility | | $54.95 | $56.23 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19,054.61 / $19,054.61 / $19,054.61
| Professional | | $19,054.61 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,818.38 / $5,248.07
| Facility | | $2,041.74 | $2,818.38 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,570.40 / $3,981.07
| Professional | | $2,089.30 | $2,570.40 | $3,981.07 |
- 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
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $4,365.16 / $7,413.10
| Professional | | $7.08 | $4,365.16 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,818.38 / $5,011.87
| Facility | | $2,089.30 | $2,818.38 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,818.38 / $5,128.61
| Professional | | $776.25 | $2,818.38 | $5,128.61 |
- 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
- $1,819.70 / $2,454.71 / $3,801.89
| Professional | | $1,819.70 | $2,454.71 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,238.72 / $2,511.89
| Professional | | $1,698.24 | $2,238.72 | $2,511.89 |