- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,884.03 / $5,623.41
| Facility | | $1,819.70 | $2,884.03 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,348.96 / $2,187.76
| Professional | | $1,000.00 | $1,348.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $97.72 / $97.72
| Facility | | $85.11 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,348.96 / $2,570.40
| Professional | | $467.74 | $1,348.96 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $1,445.44 / $3,019.95
| Facility | | $85.11 | $1,445.44 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,949.84 / $3,981.07
| Professional | | $1,348.96 | $1,949.84 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,019.95 / $7,762.47
| Facility | | $758.58 | $3,019.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $416.87 / $1,288.25
| Professional | | $245.47 | $416.87 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,071.52 / $2,290.87
| Professional | | $851.14 | $1,071.52 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $4,365.16 / $5,128.61
| Facility | | $4,365.16 | $4,365.16 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $5,495.41 / $10,232.93
| Professional | | $5,495.41 | $5,495.41 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $1,412.54 / $1,698.24
| Professional | | $69.18 | $1,412.54 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,000.00 / $4,265.80
| Facility | | $141.25 | $1,000.00 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $1,288.25
| Professional | | $239.88 | $407.38 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,511.89 / $3,630.78
| Facility | | $1,548.82 | $2,511.89 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,819.70 / $4,365.16
| Professional | | $831.76 | $1,819.70 | $4,365.16 |