- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $2,454.71 / $3,388.44
| Facility | | $977.24 | $2,454.71 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $776.25 / $1,148.15
| Professional | | $309.03 | $776.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $4,897.79
| Facility | | $1,148.15 | $1,148.15 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $933.25
| Professional | | $537.03 | $537.03 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,096.48 / $1,862.09
| Professional | | $891.25 | $1,096.48 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $2,238.72 / $5,248.07
| Facility | | $870.96 | $2,238.72 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $707.95 / $1,905.46
| Professional | | $575.44 | $707.95 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,288.25 / $1,621.81
| Professional | | $1,148.15 | $1,288.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,548.82 / $3,630.78
| Facility | | $912.01 | $1,548.82 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $2,454.71 / $3,630.78
| Professional | | $50.12 | $2,454.71 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,584.89 / $10,000.00
| Facility | | $1,047.13 | $1,584.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,584.89 / $10,000.00
| Professional | | $1,047.13 | $1,584.89 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,148.15 / $1,380.38
| Facility | | $691.83 | $1,148.15 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $575.44 / $1,288.25
| Professional | | $489.78 | $575.44 | $1,288.25 |