- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,862.09 / $14,454.40
| Facility | | $870.96 | $1,862.09 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $912.01 / $2,290.87
| Professional | | $794.33 | $912.01 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $10,964.78 / $18,197.01
| Facility | | $6,606.93 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,778.28 / $4,168.69
| Professional | | $891.25 | $1,778.28 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,818.38 / $4,570.88
| Facility | | $2,454.71 | $2,818.38 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,691.53 / $3,090.30
| Professional | | $1,023.29 | $2,691.53 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $7,079.46 / $13,182.57
| Facility | | $912.01 | $7,079.46 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,238.72 / $2,818.38
| Professional | | $1,621.81 | $2,238.72 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $8,511.38 / $15,848.93
| Facility | | $1,000.00 | $8,511.38 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,548.82 / $5,888.44
| Professional | | $912.01 | $1,548.82 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $758.58
| Professional | | $32.36 | $33.11 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $9,332.54 / $15,848.93
| Facility | | $1,905.46 | $9,332.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,290.87 / $2,951.21
| Professional | | $1,288.25 | $2,290.87 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $2,089.30 / $3,090.30
| Professional | | $1,071.52 | $2,089.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $16,595.87 / $16,595.87
| Facility | | $11,220.18 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $4,365.16 / $7,079.46
| Professional | | $1,230.27 | $4,365.16 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $2,570.40
| Professional | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $4,365.16 / $5,248.07
| Professional | | $2,754.23 | $4,365.16 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $12,022.64 / $15,848.93
| Facility | | $7,585.78 | $12,022.64 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,445.44 / $3,890.45
| Professional | | $812.83 | $1,445.44 | $3,890.45 |