- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,630.78 / $8,912.51
| Facility | | $2,398.83 | $3,630.78 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,630.27 / $3,715.35
| Professional | | $2,089.30 | $2,630.27 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,691.53 / $3,801.89
| Professional | | $2,041.74 | $2,691.53 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,511.89 / $3,890.45
| Professional | | $2,238.72 | $2,511.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,818.38 / $4,073.80
| Professional | | $2,137.96 | $2,818.38 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,290.87 / $2,818.38
| Professional | | $1,905.46 | $2,290.87 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,890.45 / $5,011.87
| Professional | | $3,019.95 | $3,890.45 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,090.30 / $4,570.88
| Facility | | $2,290.87 | $3,090.30 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,818.38 / $10,000.00
| Facility | | $1,905.46 | $2,818.38 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,818.38 / $10,000.00
| Professional | | $1,905.46 | $2,818.38 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,311.31 / $6,309.57
| Facility | | $1,621.81 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $3,019.95 / $4,677.35
| Professional | | $1,905.46 | $3,019.95 | $4,677.35 |