- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $7,943.28 / $15,135.61
| Facility | | $4,570.88 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $812.83 / $1,737.80
| Professional | | $676.08 | $812.83 | $1,737.80 |
- 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
- $660.69 / $1,122.02 / $1,621.81
| Professional | | $660.69 | $1,122.02 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,445.44 / $2,398.83
| Professional | | $660.69 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,122.02 / $8,128.31
| Facility | | $676.08 | $1,122.02 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,412.54 / $8,317.64
| Professional | | $891.25 | $1,412.54 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,698.24 / $2,398.83
| Professional | | $1,412.54 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,445.44 / $2,398.83
| Professional | | $1,258.93 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $1,202.26 / $1,949.84
| Professional | | $7.08 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $7,762.47 / $10,000.00
| Facility | | $6,918.31 | $7,762.47 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,122.02 / $1,862.09
| Professional | | $891.25 | $1,122.02 | $1,862.09 |