- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,630.78 / $9,549.93
| Facility | | $1,862.09 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,862.09 / $3,311.31
| Professional | | $1,621.81 | $1,862.09 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $13,182.57 / $15,488.17
| Facility | | $9,772.37 | $13,182.57 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,630.27 / $4,466.84
| Professional | | $1,737.80 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,818.38 / $12,022.64
| Professional | | $1,905.46 | $2,818.38 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,570.40 / $3,981.07
| Professional | | $1,737.80 | $2,570.40 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,995.26 / $2,344.23
| Professional | | $1,584.89 | $1,995.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,073.80 / $4,168.69
| Professional | | $3,235.94 | $4,073.80 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,398.83 / $3,801.89
| Facility | | $1,778.28 | $2,398.83 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $2,884.03
| Professional | | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,511.89 / $10,000.00
| Facility | | $1,737.80 | $2,511.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,511.89 / $10,000.00
| Professional | | $1,737.80 | $2,511.89 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $11,748.98 / $26,302.68
| Facility | | $7,413.10 | $11,748.98 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,454.71 / $3,981.07
| Professional | | $1,513.56 | $2,454.71 | $3,981.07 |