- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $7,585.78 / $14,454.40
| Facility | | $4,265.80 | $7,585.78 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,621.81 / $7,585.78
| Professional | | $1,288.25 | $1,621.81 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,232.93 / $13,489.63 / $26,302.68
| Facility | | $10,232.93 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,137.96 / $3,090.30
| Professional | | $1,258.93 | $2,137.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,235.94 / $4,265.80
| Professional | | $1,513.56 | $3,235.94 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,090.30 / $8,912.51
| Facility | | $1,659.59 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,951.21 / $11,481.54
| Professional | | $1,819.70 | $2,951.21 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,311.31 / $4,365.16
| Professional | | $3,090.30 | $3,311.31 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $3,090.30
| Professional | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $2,570.40 / $3,467.37
| Professional | | $3.02 | $2,570.40 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,918.31 / $9,120.11
| Facility | | $6,309.57 | $6,918.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,630.27 / $3,548.13
| Professional | | $1,819.70 | $2,630.27 | $3,548.13 |