- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $4,265.80 / $8,128.31
| Facility | | $1,258.93 | $4,265.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,348.96 / $2,570.40
| Professional | | $1,148.15 | $1,348.96 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $2,818.38
| Facility | | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,778.28 / $3,715.35
| Professional | | $1,202.26 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $5,623.41
| Facility | | $398.11 | $398.11 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,778.28 / $3,090.30
| Professional | | $1,258.93 | $1,778.28 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $3,019.95
| Professional | | $2,238.72 | $2,238.72 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,659.59 / $2,630.27
| Facility | | $1,258.93 | $1,659.59 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,041.74 / $2,344.23
| Professional | | $1,737.80 | $2,041.74 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $11,748.98 / $19,498.45
| Facility | | $5,370.32 | $11,748.98 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,479.11 / $2,511.89
| Professional | | $1,047.13 | $1,479.11 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19,498.45 / $23,442.29 / $23,442.29
| Facility | | $19,498.45 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $10,000.00 / $11,220.18
| Professional | | $10,000.00 | $10,000.00 | $11,220.18 |