- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $10,000.00 / $16,595.87
| Facility | | $3,090.30 | $10,000.00 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,995.26 / $2,570.40
| Professional | | $1,513.56 | $1,995.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $12,302.69 / $12,302.69
| Facility | | $6,165.95 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $13.18 / $5,011.87
| Professional | | $9.12 | $13.18 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $4,677.35 / $6,918.31
| Facility | | $1,778.28 | $4,677.35 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,905.46 / $4,265.80
| Professional | | $1,445.44 | $1,905.46 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,548.13 / $7,943.28
| Facility | | $1,698.24 | $3,548.13 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,691.53 / $3,715.35
| Professional | | $2,454.71 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,691.53 / $4,265.80
| Professional | | $2,187.76 | $2,691.53 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $11,748.98 / $11,748.98
| Facility | | $11,748.98 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12,302.69 / $18,197.01 / $18,197.01
| Professional | | $12,302.69 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,951.21 / $5,623.41
| Facility | | $1,659.59 | $2,951.21 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,691.53 / $3,715.35
| Professional | | $2,454.71 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,754.23 / $37,153.52
| Professional | | $1,949.84 | $2,754.23 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,454.71 / $2,951.21
| Facility | | $1,023.29 | $2,454.71 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $4,897.79
| Professional | | $1,023.29 | $1,023.29 | $4,897.79 |