- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,128.61 / $11,481.54
| Professional | | $3,890.45 | $5,128.61 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $9,772.37 / $10,964.78
| Facility | | $1,659.59 | $9,772.37 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $7,244.36 / $7,585.78
| Professional | | $1,096.48 | $7,244.36 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $4,365.16 / $4,570.88
| Facility | | $4,365.16 | $4,365.16 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $3,715.35 / $5,128.61
| Professional | | $724.44 | $3,715.35 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $5,128.61 / $7,943.28
| Facility | | $1,000.00 | $5,128.61 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,128.61 / $11,481.54
| Professional | | $3,890.45 | $5,128.61 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $478.63 / $4,897.79
| Professional | | $363.08 | $478.63 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $7,244.36 / $7,585.78
| Professional | | $7,244.36 | $7,244.36 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $6,918.31 / $6,918.31
| Professional | | $5,128.61 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $676.08 / $4,570.88
| Facility | | $346.74 | $676.08 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,884.03 / $4,570.88
| Professional | | $2,691.53 | $2,884.03 | $4,570.88 |