- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $2,511.89 / $7,585.78
| Facility | | $870.96 | $2,511.89 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,230.27 / $1,949.84
| Professional | | $1,047.13 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,096.48 / $1,230.27
| Professional | | $1,071.52 | $1,096.48 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,479.11 / $2,344.23
| Professional | | $1,122.02 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $7,244.36
| Facility | | $54.95 | $56.23 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $10,000.00 / $10,000.00
| Professional | | $8,128.31 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,548.82 / $4,073.80
| Facility | | $954.99 | $1,548.82 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,584.89 / $2,290.87
| Professional | | $1,122.02 | $1,584.89 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $154.88
| Professional | | $32.36 | $33.11 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $1,949.84 / $2,951.21
| Professional | | $6.03 | $1,949.84 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,412.54 / $2,570.40
| Facility | | $1,096.48 | $1,412.54 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,479.11 / $2,344.23
| Professional | | $1,071.52 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,513.56 / $3,630.78
| Facility | | $323.59 | $1,513.56 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,258.93 / $2,041.74
| Professional | | $912.01 | $1,258.93 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,148.15 / $1,148.15
| Professional | | $1,047.13 | $1,148.15 | $1,148.15 |