- 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 / $851.14 / $3,890.45
| Professional | | $676.08 | $851.14 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $9,120.11 / $17,782.79
| Facility | | $6,918.31 | $9,120.11 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,096.48 / $1,621.81
| Professional | | $645.65 | $1,096.48 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,659.59 / $2,187.76
| Professional | | $776.25 | $1,659.59 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,584.89 / $9,772.37
| Facility | | $851.14 | $1,584.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,479.11 / $7,244.36
| Professional | | $912.01 | $1,479.11 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,659.59 / $2,290.87
| Professional | | $1,584.89 | $1,659.59 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,584.89
| Professional | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $1,230.27 / $1,862.09
| Professional | | $6.03 | $1,230.27 | $1,862.09 |
- 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
- $912.01 / $1,348.96 / $1,819.70
| Professional | | $912.01 | $1,348.96 | $1,819.70 |