- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,630.78 / $9,549.93
| Facility | | $2,137.96 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,089.30 / $3,162.28
| Professional | | $1,659.59 | $2,089.30 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $10,232.93 / $13,489.63
| Facility | | $6,760.83 | $10,232.93 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,137.96 / $3,019.95
| Professional | | $1,621.81 | $2,137.96 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,862.09 / $2,884.03
| Professional | | $1,659.59 | $1,862.09 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,238.72 / $3,311.31
| Professional | | $1,698.24 | $2,238.72 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,862.09 / $2,290.87
| Professional | | $1,548.82 | $1,862.09 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,019.95 / $3,981.07
| Professional | | $2,344.23 | $3,019.95 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,511.89 / $3,630.78
| Facility | | $1,778.28 | $2,511.89 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,238.72 / $10,000.00
| Facility | | $1,513.56 | $2,238.72 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,238.72 / $10,000.00
| Professional | | $1,513.56 | $2,238.72 | $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
- $1,513.56 / $2,344.23 / $3,801.89
| Professional | | $1,513.56 | $2,344.23 | $3,801.89 |