- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $4,677.35 / $13,489.63
| Facility | | $1,380.38 | $4,677.35 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,202.26 / $1,995.26
| Professional | | $1,000.00 | $1,202.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $1,258.93
| Professional | | $954.99 | $954.99 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $13,489.63 / $25,703.96
| Facility | | $6,760.83 | $13,489.63 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,288.25 / $1,778.28
| Professional | | $1,023.29 | $1,288.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $977.24
| Facility | | $165.96 | $165.96 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $7,079.46 / $7,079.46
| Facility | | $7,079.46 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,513.56 / $2,398.83
| Professional | | $1,122.02 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $12,589.25 / $28,840.32
| Facility | | $2,818.38 | $12,589.25 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $9,332.54 / $9,332.54
| Professional | | $8,912.51 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,905.46 / $8,128.31
| Facility | | $1,023.29 | $1,905.46 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,479.11 / $2,511.89
| Professional | | $1,047.13 | $1,479.11 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $891.25
| Professional | | $32.36 | $33.11 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $2,187.76 / $2,818.38
| Professional | | $6.03 | $2,187.76 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,412.54 / $2,398.83
| Facility | | $977.24 | $1,412.54 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,513.56 / $2,344.23
| Professional | | $1,096.48 | $1,513.56 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $8,128.31 / $16,218.10
| Facility | | $2,630.27 | $8,128.31 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,258.93 / $1,995.26
| Professional | | $933.25 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,023.29 / $1,023.29
| Professional | | $954.99 | $1,023.29 | $1,023.29 |