- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,454.71 / $8,317.64
| Facility | | $1,202.26 | $2,454.71 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,862.09 / $3,981.07
| Professional | | $1,479.11 | $1,862.09 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $5,370.32 / $5,370.32
| Professional | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $10,000.00 / $14,125.38
| Facility | | $10,000.00 | $10,000.00 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,467.37 / $4,365.16
| Professional | | $1,862.09 | $3,467.37 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,290.87 / $4,073.80
| Professional | | $1,621.81 | $2,290.87 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $3,801.89
| Professional | | $2,754.23 | $2,754.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,089.30 / $3,311.31
| Facility | | $1,621.81 | $2,089.30 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,818.38 / $3,548.13
| Professional | | $2,238.72 | $2,818.38 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $14,791.08 / $23,442.29
| Facility | | $5,623.41 | $14,791.08 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,819.70 / $3,467.37
| Professional | | $1,380.38 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $23,442.29 / $23,442.29
| Facility | | $56.23 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $11,748.98 / $14,125.38
| Professional | | $11,748.98 | $11,748.98 | $14,125.38 |