- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $4,365.16 / $11,481.54
| Facility | | $1,659.59 | $4,365.16 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,348.96 / $3,388.44
| Professional | | $1,148.15 | $1,348.96 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $6,165.95 / $8,709.64
| Facility | | $6,165.95 | $6,165.95 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,621.81 / $3,630.78
| Professional | | $1,380.38 | $1,621.81 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,698.24 / $2,754.23
| Professional | | $1,258.93 | $1,698.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,951.21
| Professional | | $2,041.74 | $2,041.74 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,621.81 / $2,570.40
| Facility | | $1,258.93 | $1,621.81 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,137.96 / $2,570.40
| Professional | | $1,995.26 | $2,137.96 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $11,748.98 / $19,498.45
| Facility | | $4,677.35 | $11,748.98 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,380.38 / $2,570.40
| Professional | | $1,071.52 | $1,380.38 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $21,379.62 / $21,379.62
| Facility | | $56.23 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $10,000.00 / $10,964.78
| Professional | | $10,000.00 | $10,000.00 | $10,964.78 |