- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $3,630.78 / $9,549.93
| Facility | | $1,548.82 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,513.56 / $2,344.23
| Professional | | $1,230.27 | $1,513.56 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $10,964.78 / $14,791.08
| Facility | | $6,918.31 | $10,964.78 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,584.89 / $2,187.76
| Professional | | $1,202.26 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $933.25 / $2,187.76
| Professional | | $691.83 | $933.25 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,698.24 / $2,398.83
| Professional | | $1,258.93 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,318.26 / $1,621.81
| Professional | | $1,096.48 | $1,318.26 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,137.96 / $2,951.21
| Professional | | $1,737.80 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,905.46 / $2,754.23
| Facility | | $1,230.27 | $1,905.46 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,737.80 / $10,000.00
| Facility | | $1,174.90 | $1,737.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,737.80 / $10,000.00
| Professional | | $1,174.90 | $1,737.80 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,311.31 / $6,309.57
| Facility | | $1,584.89 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,737.80 / $2,754.23
| Professional | | $1,122.02 | $1,737.80 | $2,754.23 |