- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $10,000.00 / $22,908.68
| Facility | | $3,715.35 | $10,000.00 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,548.82 / $5,011.87
| Professional | | $1,202.26 | $1,548.82 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $11,481.54 / $18,620.87
| Facility | | $6,918.31 | $11,481.54 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,621.81 / $3,162.28
| Professional | | $1,258.93 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $3,801.89 / $7,079.46
| Facility | | $79.43 | $3,801.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,778.28 / $3,467.37
| Professional | | $1,258.93 | $1,778.28 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $724.44 / $1,023.29
| Facility | | $616.60 | $724.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,659.59 / $3,162.28
| Professional | | $1,122.02 | $1,659.59 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,202.26 / $1,819.70
| Professional | | $794.33 | $1,202.26 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,380.38 / $3,019.95
| Professional | | $1,148.15 | $1,380.38 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $8,511.38
| Facility | | $54.95 | $56.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $11,748.98 / $11,748.98
| Professional | | $9,549.93 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,995.26
| Professional | | $32.36 | $33.11 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,698.24 / $2,691.53
| Facility | | $1,258.93 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,659.59 / $3,467.37
| Professional | | $1,023.29 | $1,659.59 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $4,365.16 / $4,365.16
| Professional | | $4,365.16 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,288.25 / $1,698.24
| Professional | | $1,000.00 | $1,288.25 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $5,495.41 / $17,378.01
| Facility | | $1,698.24 | $5,495.41 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,479.11 / $2,951.21
| Professional | | $1,096.48 | $1,479.11 | $2,951.21 |