- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,715.35 / $12,882.50
| Facility | | $1,000.00 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,630.27 / $3,630.78
| Professional | | $1,819.70 | $2,630.27 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,691.53 / $3,630.78
| Professional | | $2,089.30 | $2,691.53 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,818.38 / $4,365.16
| Professional | | $2,041.74 | $2,818.38 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $14,454.40
| Facility | | $54.95 | $56.23 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16,218.10 / $19,952.62 / $19,952.62
| Professional | | $16,218.10 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,884.03 / $6,309.57
| Facility | | $1,584.89 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,019.95 / $4,570.88
| Professional | | $2,290.87 | $3,019.95 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,862.09
| Professional | | $32.36 | $33.11 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,691.53 / $5,128.61
| Facility | | $1,862.09 | $2,691.53 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,884.03 / $4,365.16
| Professional | | $2,089.30 | $2,884.03 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,344.23 / $8,912.51
| Facility | | $446.68 | $2,344.23 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,344.23 / $3,890.45
| Professional | | $1,737.80 | $2,344.23 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,089.30 / $2,290.87
| Professional | | $2,089.30 | $2,089.30 | $2,290.87 |