- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $4,466.84 / $9,549.93
| Facility | | $2,691.53 | $4,466.84 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,691.53 / $3,890.45
| Professional | | $2,290.87 | $2,691.53 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,803.84 / $22,908.68 / $30,199.52
| Facility | | $13,803.84 | $22,908.68 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,235.94 / $4,677.35
| Professional | | $2,454.71 | $3,235.94 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,162.28 / $4,265.80
| Professional | | $2,511.89 | $3,162.28 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,951.21 / $5,623.41
| Professional | | $2,041.74 | $2,951.21 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,019.95 / $8,128.31
| Professional | | $2,511.89 | $3,019.95 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,311.31 / $5,888.44
| Professional | | $2,630.27 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,235.94 / $4,897.79
| Facility | | $2,511.89 | $3,235.94 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,090.30 / $10,000.00
| Facility | | $1,862.09 | $3,090.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,090.30 / $10,000.00
| Professional | | $1,862.09 | $3,090.30 | $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
- $1,949.84 / $2,754.23 / $4,786.30
| Professional | | $1,949.84 | $2,754.23 | $4,786.30 |