- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $4,897.79 / $10,964.78
| Facility | | $1,047.13 | $4,897.79 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,047.13 / $1,905.46
| Professional | | $851.14 | $1,047.13 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Professional | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $6,309.57 / $12,302.69
| Facility | | $1,000.00 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,000.00 / $1,148.15
| Professional | | $741.31 | $1,000.00 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $398.11 / $1,659.59
| Facility | | $323.59 | $398.11 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,288.25 / $2,089.30
| Professional | | $812.83 | $1,288.25 | $2,089.30 |
- 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
- $575.44 / $707.95 / $1,096.48
| Professional | | $575.44 | $707.95 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,412.54
| Professional | | $32.36 | $33.11 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $4,897.79 / $9,549.93
| Facility | | $676.08 | $4,897.79 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,047.13 / $1,949.84
| Professional | | $724.44 | $1,047.13 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $1,023.29
| Professional | | $758.58 | $758.58 | $1,023.29 |