- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $4,786.30 / $10,232.93
| Facility | | $1,047.13 | $4,786.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,000.00 / $2,511.89
| Professional | | $724.44 | $1,000.00 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,495.41 / $12,882.50
| Facility | | $3,388.44 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $812.83 / $1,949.84
| Professional | | $645.65 | $812.83 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,995.26 / $8,912.51
| Facility | | $1,096.48 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $4,786.30 / $53,703.18
| Facility | | $1,318.26 | $4,786.30 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,380.38 / $3,548.13
| Professional | | $575.44 | $1,380.38 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,122.02 / $2,691.53
| Facility | | $812.83 | $1,122.02 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,000.00 / $1,479.11
| Professional | | $741.31 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,071.52 / $1,659.59
| Professional | | $660.69 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $9,120.11
| Facility | | $7,413.10 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $50,118.72 / $75,857.76
| Facility | | $870.96 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,047.13 / $1,698.24
| Professional | | $398.11 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $4,897.79 / $10,232.93
| Facility | | $2,398.83 | $4,897.79 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,023.29 / $2,511.89
| Professional | | $602.56 | $1,023.29 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,047.13 / $2,630.27
| Facility | | $630.96 | $1,047.13 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,047.13 / $2,454.71
| Professional | | $630.96 | $1,047.13 | $2,454.71 |