- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $5,495.41 / $8,511.38
| Facility | | $1,778.28 | $5,495.41 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,071.52 / $2,398.83
| Professional | | $831.76 | $1,071.52 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,786.30 / $8,912.51
| Facility | | $2,238.72 | $4,786.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,096.48 / $1,621.81
| Professional | | $891.25 | $1,096.48 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $812.83 / $1,380.38
| Professional | | $758.58 | $812.83 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $7,762.47 / $10,232.93
| Facility | | $4,365.16 | $7,762.47 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,174.90 / $2,187.76
| Professional | | $295.12 | $1,174.90 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,570.40 / $26,302.68
| Facility | | $1,000.00 | $2,570.40 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,621.81 / $4,570.88 / $4,570.88
| Facility | 54 | $1,621.81 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,174.90 / $6,760.83
| Professional | | $851.14 | $1,174.90 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,398.83 / $4,677.35
| Facility | | $1,819.70 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,023.29 / $1,659.59
| Professional | | $794.33 | $1,023.29 | $1,659.59 |