- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $6,606.93 / $15,135.61
| Facility | | $1,047.13 | $6,606.93 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,348.96 / $2,754.23
| Professional | | $1,000.00 | $1,348.96 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,174.90 / $2,238.72
| Professional | | $588.84 | $1,174.90 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $6,309.57 / $12,302.69
| Facility | | $1,174.90 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,202.26 / $1,380.38
| Professional | | $891.25 | $1,202.26 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $398.11 / $10,000.00
| Facility | | $323.59 | $398.11 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,479.11 / $2,398.83
| Professional | | $1,023.29 | $1,479.11 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $23,442.29 / $34,673.69
| Facility | | $10,000.00 | $23,442.29 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $794.33 / $1,202.26
| Professional | | $741.31 | $794.33 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,479.11
| Professional | | $32.36 | $33.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $7,943.28 / $12,882.50
| Facility | | $2,630.27 | $7,943.28 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,380.38 / $2,511.89
| Professional | | $954.99 | $1,380.38 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $1,230.27
| Professional | | $891.25 | $891.25 | $1,230.27 |