- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $4,365.16 / $10,471.29
| Facility | | $1,659.59 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,202.26 / $2,290.87
| Professional | | $1,047.13 | $1,202.26 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,511.89 / $3,388.44
| Professional | | $1,412.54 | $2,511.89 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $7,943.28
| Facility | | $741.31 | $741.31 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,778.28 / $2,570.40
| Professional | | $1,230.27 | $1,778.28 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,344.23 / $2,691.53
| Professional | | $2,344.23 | $2,344.23 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,621.81 / $2,570.40
| Facility | | $1,148.15 | $1,621.81 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,041.74 / $2,511.89
| Professional | | $1,584.89 | $2,041.74 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $14,791.08 / $23,442.29
| Facility | | $5,623.41 | $14,791.08 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,380.38 / $2,454.71
| Professional | | $977.24 | $1,380.38 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28,840.32 / $28,840.32 / $33,884.42
| Facility | | $28,840.32 | $28,840.32 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $9,120.11 / $10,000.00
| Professional | | $9,120.11 | $9,120.11 | $10,000.00 |