- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $7,943.28 / $20,892.96
| Facility | | $1,584.89 | $7,943.28 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,071.52 / $2,089.30
| Professional | | $794.33 | $1,071.52 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $13,803.84 / $28,183.83
| Facility | | $9,772.37 | $13,803.84 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,621.81 / $2,137.96
| Professional | | $1,148.15 | $1,621.81 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $6,025.60
| Facility | | $3,548.13 | $3,548.13 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,584.89 / $2,511.89
| Professional | | $1,000.00 | $1,584.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,995.26 / $13,182.57
| Facility | | $1,096.48 | $1,995.26 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,862.09 / $4,897.79
| Professional | | $1,047.13 | $1,862.09 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $56.23
| Professional | | $32.36 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,621.81 / $1,698.24
| Facility | | $1,380.38 | $1,621.81 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,148.15
| Facility | | $1,122.02 | $1,122.02 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,778.28 / $2,454.71
| Professional | | $1,148.15 | $1,778.28 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $14,454.40 / $28,183.83
| Facility | | $9,549.93 | $14,454.40 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,621.81 / $2,238.72
| Professional | | $1,148.15 | $1,621.81 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $16,595.87 / $30,902.95
| Facility | | $3,467.37 | $16,595.87 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,318.26 / $2,290.87
| Professional | | $870.96 | $1,318.26 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,023.29 / $1,548.82
| Professional | | $812.83 | $1,023.29 | $1,548.82 |