- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $8,912.51 / $11,748.98
| Facility | | $1,698.24 | $8,912.51 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,698.24 / $3,890.45
| Professional | | $1,445.44 | $1,698.24 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $9,549.93 / $21,877.62
| Facility | | $2,511.89 | $9,549.93 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,698.24 / $2,951.21
| Professional | | $1,318.26 | $1,698.24 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,584.89 / $1,862.09
| Facility | | $1,548.82 | $1,584.89 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,089.30 / $21,379.62
| Facility | | $1,348.96 | $2,089.30 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,137.96 / $3,235.94
| Professional | | $676.08 | $2,137.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $2,187.76 / $3,311.31
| Professional | | $660.69 | $2,187.76 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,819.70 / $3,467.37
| Professional | | $1,548.82 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,090.30 / $5,754.40
| Facility | | $1,819.70 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,949.84 / $3,019.95
| Professional | | $1,412.54 | $1,949.84 | $3,019.95 |