- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $6,456.54 / $11,481.54
| Facility | | $1,000.00 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,801.89 / $31,622.78
| Professional | | $1,000.00 | $3,801.89 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Professional | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $11,220.18 / $23,988.33
| Facility | | $2,238.72 | $11,220.18 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $3,162.28 / $7,762.47
| Professional | | $1,905.46 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $10,964.78 / $14,125.38
| Facility | | $3,467.37 | $10,964.78 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,801.89 / $9,549.93
| Professional | | $2,818.38 | $3,801.89 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $8,317.64 / $15,848.93
| Facility | | $3,388.44 | $8,317.64 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,890.45 / $9,332.54
| Professional | | $2,398.83 | $3,890.45 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $5,248.07 / $6,456.54
| Professional | | $4,786.30 | $5,248.07 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $5,011.87 / $8,317.64
| Professional | | $3,801.89 | $5,011.87 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22,908.68 / $22,908.68 / $22,908.68
| Facility | | $22,908.68 | $22,908.68 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23,988.33 / $35,481.34 / $35,481.34
| Professional | | $23,988.33 | $35,481.34 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,398.83
| Professional | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $4,897.79 / $11,748.98
| Facility | | $2,511.89 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $5,128.61 / $9,549.93
| Professional | | $2,570.40 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16,595.87 / $16,595.87 / $16,595.87
| Professional | | $16,595.87 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,311.31 / $5,011.87
| Facility | | $2,137.96 | $3,311.31 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,137.96 / $8,709.64
| Professional | | $1,995.26 | $2,137.96 | $8,709.64 |