- 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
- $1,778.28 / $2,137.96 / $3,388.44
| Professional | | $1,778.28 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,089.30 / $2,818.38
| Professional | | $1,659.59 | $2,089.30 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $1,949.84 / $2,041.74
| Facility | | $79.43 | $1,949.84 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,630.78 / $6,918.31
| Facility | | $3,548.13 | $3,630.78 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,754.23 / $4,265.80
| Professional | | $1,949.84 | $2,754.23 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $12,589.25
| Facility | | $5,011.87 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14,454.40 / $18,620.87 / $18,620.87
| Professional | | $14,454.40 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,630.27 / $4,897.79
| Facility | | $1,819.70 | $2,630.27 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,754.23 / $4,073.80
| Professional | | $1,862.09 | $2,754.23 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,778.28
| Professional | | $32.36 | $33.11 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $7,244.36 / $7,413.10
| Professional | | $2,238.72 | $7,244.36 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,570.40 / $4,570.88
| Facility | | $1,949.84 | $2,570.40 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,754.23 / $4,265.80
| Professional | | $1,949.84 | $2,754.23 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $2,344.23 / $8,912.51
| Facility | | $467.74 | $2,344.23 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,187.76 / $3,467.37
| Professional | | $1,659.59 | $2,187.76 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $2,187.76
| Professional | | $1,949.84 | $1,949.84 | $2,187.76 |