- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $7,943.28 / $10,471.29
| Facility | | $3,162.28 | $7,943.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,235.94 / $5,011.87
| Professional | | $2,754.23 | $3,235.94 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16,595.87 / $21,877.62 / $26,302.68
| Facility | | $16,595.87 | $21,877.62 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $363.08
| Professional | | $208.93 | $208.93 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,548.13 / $3,890.45
| Professional | | $3,235.94 | $3,548.13 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $10,000.00 / $21,379.62
| Facility | | $2,691.53 | $10,000.00 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,570.88 / $5,888.44
| Professional | | $4,168.69 | $4,570.88 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $4,073.80 / $7,079.46
| Facility | | $3,162.28 | $4,073.80 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $2,691.53
| Professional | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,786.30 / $8,511.38
| Facility | | $2,951.21 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,786.30 / $8,709.64
| Professional | | $2,951.21 | $4,786.30 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $4,168.69 / $5,011.87
| Facility | | $2,511.89 | $4,168.69 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,089.30 / $4,570.88
| Professional | | $1,737.80 | $2,089.30 | $4,570.88 |