- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $4,466.84 / $9,549.93
| Facility | | $2,754.23 | $4,466.84 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,754.23 / $3,630.78
| Professional | | $2,290.87 | $2,754.23 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $19,054.61 / $25,118.86
| Facility | | $8,709.64 | $19,054.61 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,235.94 / $4,570.88
| Professional | | $2,398.83 | $3,235.94 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,090.30 / $4,265.80
| Professional | | $2,511.89 | $3,090.30 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,235.94 / $5,370.32
| Professional | | $2,187.76 | $3,235.94 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,630.27 / $6,760.83
| Professional | | $2,187.76 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,073.80 / $6,025.60
| Professional | | $2,951.21 | $4,073.80 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,467.37 / $5,128.61
| Facility | | $2,454.71 | $3,467.37 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,235.94 / $10,000.00
| Facility | | $2,187.76 | $3,235.94 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,235.94 / $10,000.00
| Professional | | $2,187.76 | $3,235.94 | $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
- $2,041.74 / $3,162.28 / $5,011.87
| Professional | | $2,041.74 | $3,162.28 | $5,011.87 |