- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $7,943.28 / $14,454.40
| Facility | | $2,089.30 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,148.15 / $2,089.30
| Professional | | $1,023.29 | $1,148.15 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $8,317.64 / $16,218.10
| Facility | | $6,456.54 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,698.24 / $2,238.72
| Professional | | $977.24 | $1,698.24 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,187.76 / $3,630.78
| Professional | | $676.08 | $2,187.76 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,659.59 / $3,715.35
| Facility | | $1,023.29 | $1,659.59 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,089.30 / $10,000.00
| Professional | | $1,230.27 | $2,089.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $3,630.78
| Professional | | $2,137.96 | $2,570.40 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,187.76 / $3,630.78
| Professional | | $1,905.46 | $2,187.76 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $1,380.38 / $2,951.21
| Professional | | $7.08 | $1,380.38 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,466.84 / $8,128.31
| Facility | | $3,235.94 | $4,466.84 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,621.81 / $2,691.53
| Professional | | $1,230.27 | $1,621.81 | $2,691.53 |