- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,786.30 / $9,549.93
| Facility | | $3,235.94 | $4,786.30 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,168.69 / $5,888.44
| Professional | | $3,388.44 | $4,168.69 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $12,302.69 / $17,782.79
| Facility | | $9,772.37 | $12,302.69 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,265.80 / $6,025.60
| Professional | | $3,235.94 | $4,265.80 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $3,981.07 / $6,165.95
| Professional | | $3,630.78 | $3,981.07 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,570.88 / $6,606.93
| Professional | | $3,388.44 | $4,570.88 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,630.78 / $4,466.84
| Professional | | $3,019.95 | $3,630.78 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $5,370.32 / $7,943.28
| Professional | | $4,365.16 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,897.79 / $7,244.36
| Facility | | $3,467.37 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,466.84 / $10,000.00
| Facility | | $2,344.23 | $4,466.84 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,466.84 / $10,000.00
| Professional | | $2,344.23 | $4,466.84 | $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
- $3,090.30 / $4,786.30 / $7,762.47
| Professional | | $3,090.30 | $4,786.30 | $7,762.47 |