- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $7,413.10 / $9,772.37
| Facility | | $1,000.00 | $7,413.10 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,630.27 / $6,456.54
| Professional | | $1,000.00 | $2,630.27 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,801.89 / $15,848.93
| Facility | | $2,454.71 | $3,801.89 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,311.31 / $9,772.37
| Professional | | $1,995.26 | $3,311.31 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $6,606.93 / $9,549.93
| Facility | | $5,248.07 | $6,606.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $3,235.94
| Professional | | $3,090.30 | $3,090.30 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,630.27 / $5,370.32
| Facility | | $2,187.76 | $2,630.27 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,801.89 / $6,918.31
| Professional | | $1,995.26 | $3,801.89 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $5,623.41 / $9,772.37
| Facility | | $83.18 | $5,623.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $5,623.41
| Professional | | $4,786.30 | $4,786.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $6,025.60
| Professional | | $3,311.31 | $3,311.31 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,801.89 / $15,848.93
| Facility | | $2,454.71 | $3,801.89 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,311.31 / $9,772.37
| Professional | | $1,995.26 | $3,311.31 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,311.31 / $3,981.07
| Facility | | $1,659.59 | $3,311.31 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,311.31 / $6,309.57
| Professional | | $1,995.26 | $3,311.31 | $6,309.57 |