- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,715.35 / $12,882.50
| Facility | | $1,000.00 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $645.65 / $1,000.00
| Professional | | $512.86 | $645.65 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,786.30 / $9,120.11
| Facility | | $2,570.40 | $4,786.30 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $660.69 / $891.25
| Professional | | $524.81 | $660.69 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $2,754.23 / $2,754.23
| Facility | | $512.86 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $758.58 / $1,202.26
| Professional | | $575.44 | $758.58 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $33,884.42 / $33,884.42
| Facility | | $9,772.37 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $5,370.32 / $5,370.32
| Professional | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $977.24 / $5,248.07
| Facility | | $575.44 | $977.24 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $776.25 / $1,174.90
| Professional | | $549.54 | $776.25 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $457.09
| Professional | | $32.36 | $33.11 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $1,071.52 / $1,412.54
| Professional | | $3.02 | $1,071.52 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $741.31 / $1,258.93
| Facility | | $524.81 | $741.31 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $758.58 / $1,174.90
| Professional | | $575.44 | $758.58 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,630.78 / $7,244.36
| Facility | | $1,445.44 | $3,630.78 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $645.65 / $1,000.00
| Professional | | $467.74 | $645.65 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $537.03 / $537.03
| Professional | | $501.19 | $537.03 | $537.03 |