- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $4,265.80 / $7,943.28
| Facility | | $1,513.56 | $4,265.80 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,584.89 / $2,454.71
| Professional | | $1,318.26 | $1,584.89 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $10,715.19 / $12,589.25
| Facility | | $8,128.31 | $10,715.19 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $354.81
| Professional | | $199.53 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,698.24 / $1,905.46
| Professional | | $1,548.82 | $1,698.24 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $5,011.87 / $10,471.29
| Facility | | $2,089.30 | $5,011.87 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,230.27 / $3,388.44
| Professional | | $1,000.00 | $1,230.27 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,238.72 / $2,818.38
| Professional | | $2,041.74 | $2,238.72 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,238.72 / $3,467.37
| Facility | | $1,621.81 | $2,238.72 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $4,265.80
| Professional | | $1,318.26 | $1,318.26 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,754.23 / $10,000.00
| Facility | | $1,778.28 | $2,754.23 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,754.23 / $10,000.00
| Professional | | $1,778.28 | $2,754.23 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,041.74 / $2,454.71
| Facility | | $1,230.27 | $2,041.74 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,023.29 / $2,238.72
| Professional | | $851.14 | $1,023.29 | $2,238.72 |