- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $17,378.01 / $38,904.51
| Facility | | $3,630.78 | $17,378.01 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,019.95 / $3,715.35
| Professional | | $2,344.23 | $3,019.95 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,754.40 / $7,762.47
| Facility | | $3,890.45 | $5,754.40 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,890.45 / $5,011.87
| Professional | | $3,311.31 | $3,890.45 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $8,511.38 / $10,000.00
| Facility | | $4,073.80 | $8,511.38 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,890.45 / $17,782.79
| Facility | | $3,467.37 | $3,890.45 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,890.45 / $6,606.93
| Professional | | $3,467.37 | $3,890.45 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $4,265.80
| Facility | | $3,890.45 | $3,890.45 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $6,165.95 / $12,022.64
| Facility | | $3,890.45 | $6,165.95 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $4,677.35
| Professional | | $3,467.37 | $3,467.37 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $5,754.40 / $8,912.51
| Facility | | $4,466.84 | $5,754.40 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,890.45 / $5,011.87
| Professional | | $3,311.31 | $3,890.45 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,677.35 / $4,677.35
| Facility | | $3,890.45 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $4,365.16
| Professional | | $1,621.81 | $1,621.81 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,890.45 / $6,918.31
| Professional | | $1,737.80 | $3,890.45 | $6,918.31 |