- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $7,244.36 / $13,489.63
| Facility | | $1,000.00 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $1,862.09
| Professional | | $354.81 | $562.34 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $6,025.60 / $11,748.98
| Facility | | $4,570.88 | $6,025.60 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $616.60 / $954.99
| Professional | | $380.19 | $616.60 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $977.24 / $1,445.44
| Professional | | $724.44 | $977.24 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $707.95 / $4,265.80
| Facility | | $363.08 | $707.95 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $912.01 / $2,454.71
| Professional | | $549.54 | $912.01 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,000.00 / $1,380.38
| Professional | | $758.58 | $1,000.00 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,000.00 / $1,148.15
| Professional | | $645.65 | $1,000.00 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,715.35 / $6,760.83
| Facility | | $2,951.21 | $3,715.35 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $707.95 / $1,148.15
| Professional | | $407.38 | $707.95 | $1,148.15 |