- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,162.28 / $10,964.78
| Facility | | $1,584.89 | $3,162.28 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,548.82 / $4,168.69
| Professional | | $1,202.26 | $1,548.82 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,762.47 / $13,803.84
| Facility | | $4,073.80 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,318.26 / $3,235.94
| Professional | | $1,071.52 | $1,318.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $37,153.52
| Facility | | $1,819.70 | $1,819.70 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $1,819.70
| Professional | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $4,786.30 / $53,703.18
| Facility | | $34.67 | $4,786.30 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $2,290.87 / $5,754.40
| Professional | | $933.25 | $2,290.87 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,089.30 / $4,365.16
| Facility | | $1,318.26 | $2,089.30 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,621.81 / $2,398.83
| Professional | | $1,202.26 | $1,621.81 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,737.80 / $2,691.53
| Professional | | $1,000.00 | $1,737.80 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $50,118.72 / $75,857.76
| Facility | | $1,380.38 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,698.24 / $2,818.38
| Professional | | $398.11 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,951.21 / $5,754.40
| Facility | | $1,412.54 | $2,951.21 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,659.59 / $4,168.69
| Professional | | $1,000.00 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,659.59 / $4,073.80
| Facility | | $1,023.29 | $1,659.59 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,659.59 / $3,388.44
| Professional | | $1,023.29 | $1,659.59 | $3,388.44 |