- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,235.94 / $5,623.41
| Facility | | $1,819.70 | $3,235.94 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,412.54 / $2,187.76
| Professional | | $1,000.00 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $117.49 / $117.49
| Facility | | $102.33 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,905.46 / $5,754.40
| Professional | | $1,000.00 | $1,905.46 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $6,309.57 / $10,471.29
| Facility | | $2,290.87 | $6,309.57 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $288.40
| Professional | | $102.33 | $147.91 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,715.35 / $9,549.93
| Facility | | $1,174.90 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $912.01 / $2,137.96
| Professional | | $363.08 | $912.01 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,905.46 / $4,786.30
| Professional | | $1,584.89 | $1,905.46 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $5,754.40 / $5,754.40
| Professional | | $4,265.80 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,778.28 / $5,248.07
| Facility | | $151.36 | $1,778.28 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $912.01 / $2,041.74
| Professional | | $363.08 | $912.01 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $144.54 / $2,041.74
| Professional | | $85.11 | $144.54 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,951.21 / $3,801.89
| Facility | | $2,344.23 | $2,951.21 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,019.95 / $7,244.36
| Professional | | $2,137.96 | $3,019.95 | $7,244.36 |