- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $8,912.51 / $20,892.96
| Facility | | $1,862.09 | $8,912.51 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,258.93 / $4,365.16
| Professional | | $831.76 | $1,258.93 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $6,165.95 / $12,589.25
| Facility | | $4,466.84 | $6,165.95 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,041.74 / $3,019.95
| Professional | | $1,348.96 | $2,041.74 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $2,884.03
| Facility | | $1,023.29 | $1,023.29 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,621.81 / $3,090.30
| Professional | | $1,000.00 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,584.89 / $3,311.31
| Facility | | $1,174.90 | $1,584.89 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,584.89 / $2,754.23
| Professional | | $1,174.90 | $1,584.89 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $446.68
| Professional | | $32.36 | $33.11 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,819.70 / $1,995.26
| Facility | | $1,288.25 | $1,819.70 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,348.96
| Facility | | $1,318.26 | $1,318.26 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,089.30 / $2,818.38
| Professional | | $1,348.96 | $2,089.30 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $6,456.54 / $12,589.25
| Facility | | $4,265.80 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,041.74 / $3,019.95
| Professional | | $1,348.96 | $2,041.74 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $6,606.93 / $12,882.50
| Facility | | $1,288.25 | $6,606.93 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,348.96 / $2,630.27
| Professional | | $1,023.29 | $1,348.96 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $1,174.90 / $1,819.70
| Professional | | $128.82 | $1,174.90 | $1,819.70 |