- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $5,128.61 / $10,715.19
| Facility | | $1,000.00 | $5,128.61 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $575.44 / $933.25
| Professional | | $426.58 | $575.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $4,073.80 / $11,220.18
| Facility | | $851.14 | $4,073.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $478.63 / $602.56
| Professional | | $389.05 | $478.63 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,584.89 / $1,778.28
| Facility | | $630.96 | $1,584.89 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $575.44 / $1,148.15
| Professional | | $363.08 | $575.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $13,489.63 / $23,442.29
| Facility | | $6,456.54 | $13,489.63 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $426.58 / $660.69
| Professional | | $245.47 | $426.58 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $660.69
| Professional | | $32.36 | $33.11 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $7,413.10 / $12,022.64
| Facility | | $2,398.83 | $7,413.10 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $489.78 / $891.25
| Professional | | $338.84 | $489.78 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $446.68 / $602.56
| Professional | | $346.74 | $446.68 | $602.56 |