- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $6,309.57 / $10,000.00
| Facility | | $3,311.31 | $6,309.57 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,691.53 / $6,025.60
| Professional | | $1,000.00 | $2,691.53 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $8,709.64
| Facility | | $3,311.31 | $3,311.31 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $4,786.30
| Professional | | $1,318.26 | $1,318.26 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,311.31 / $3,311.31
| Facility | | $1,995.26 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,311.31 / $3,311.31
| Professional | | $2,398.83 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $7,079.46 / $12,022.64
| Facility | | $3,235.94 | $7,079.46 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $4,073.80 / $15,848.93
| Professional | | $1,995.26 | $4,073.80 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $5,495.41 / $12,882.50
| Facility | | $3,311.31 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,344.23 / $6,309.57
| Professional | | $1,659.59 | $2,344.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,162.28 / $5,888.44
| Professional | | $2,187.76 | $3,162.28 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $6,309.57 / $50,118.72
| Facility | | $4,365.16 | $6,309.57 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $3,388.44
| Professional | | $3,311.31 | $3,311.31 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,311.31 / $4,466.84
| Facility | | $2,137.96 | $3,311.31 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,344.23 / $5,011.87
| Professional | | $1,380.38 | $2,344.23 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,548.13 / $3,548.13
| Facility | | $2,818.38 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,162.28 / $7,943.28
| Professional | | $2,187.76 | $3,162.28 | $7,943.28 |