- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,230.27 / $2,041.74
| Professional | | $1,047.13 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $4,073.80
| Facility | | $2,511.89 | $2,511.89 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,344.23 / $2,754.23
| Professional | | $2,344.23 | $2,344.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $5,754.40 / $12,302.69
| Facility | | $1,380.38 | $5,754.40 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,548.13 / $4,677.35
| Professional | | $1,000.00 | $3,548.13 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,041.74 / $3,090.30
| Facility | | $1,230.27 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,454.71 / $2,951.21
| Professional | | $2,238.72 | $2,454.71 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,454.71 / $11,481.54
| Facility | | $1,230.27 | $2,454.71 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,621.81 / $2,754.23
| Professional | | $1,122.02 | $1,621.81 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $1,445.44
| Professional | | $54.95 | $70.79 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,818.38 / $4,897.79
| Professional | | $1,778.28 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,715.35 / $6,918.31
| Professional | | $2,511.89 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $5,011.87 / $11,481.54
| Facility | | $1,380.38 | $5,011.87 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,995.26 / $12,302.69
| Professional | | $1,000.00 | $1,995.26 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,659.59 / $2,511.89
| Facility | | $1,288.25 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,230.27 / $2,041.74
| Professional | | $954.99 | $1,230.27 | $2,041.74 |