- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $3,630.78 / $9,549.93
| Facility | | $977.24 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,288.25 / $2,089.30
| Professional | | $977.24 | $1,288.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $15,848.93 / $20,892.96
| Facility | | $8,709.64 | $15,848.93 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,513.56 / $2,187.76
| Professional | | $1,148.15 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,548.82 / $2,089.30
| Professional | | $1,230.27 | $1,548.82 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,445.44 / $2,454.71
| Professional | | $1,023.29 | $1,445.44 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,288.25 / $3,388.44
| Professional | | $1,071.52 | $1,288.25 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,905.46 / $2,754.23
| Professional | | $1,513.56 | $1,905.46 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,584.89 / $2,344.23
| Facility | | $1,047.13 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,548.82 / $10,000.00
| Facility | | $1,047.13 | $1,548.82 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,548.82 / $10,000.00
| Professional | | $1,047.13 | $1,548.82 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $8,128.31 / $17,378.01
| Facility | | $5,128.61 | $8,128.31 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,445.44 / $2,290.87
| Professional | | $954.99 | $1,445.44 | $2,290.87 |