- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $8,912.51 / $11,748.98
| Facility | | $2,951.21 | $8,912.51 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,818.38 / $5,128.61
| Professional | | $2,454.71 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $7,079.46 / $22,908.68
| Facility | | $3,235.94 | $7,079.46 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,019.95 / $4,786.30
| Professional | | $2,290.87 | $3,019.95 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $3,090.30
| Facility | | $2,630.27 | $2,630.27 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,365.16 / $21,379.62
| Facility | | $2,818.38 | $4,365.16 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,467.37 / $5,370.32
| Professional | | $2,454.71 | $3,467.37 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,467.37 / $5,128.61
| Professional | | $2,398.83 | $3,467.37 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $524.81
| Professional | | $32.36 | $33.11 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $21,379.62
| Facility | | $100.00 | $100.00 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,951.21 / $5,623.41
| Professional | | $2,398.83 | $2,951.21 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $13,803.84 / $21,379.62
| Facility | | $6,918.31 | $13,803.84 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,884.03 / $4,786.30
| Professional | | $1,995.26 | $2,884.03 | $4,786.30 |