- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $5,495.41 / $10,000.00
| Facility | | $2,290.87 | $5,495.41 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,290.87 / $3,467.37
| Professional | | $1,905.46 | $2,290.87 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,691.53 / $3,890.45
| Professional | | $2,041.74 | $2,691.53 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,388.44 / $10,000.00
| Professional | | $2,398.83 | $3,388.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,754.23 / $4,466.84
| Professional | | $1,905.46 | $2,754.23 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,137.96 / $5,623.41
| Professional | | $1,778.28 | $2,137.96 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,467.37 / $5,011.87
| Professional | | $2,691.53 | $3,467.37 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,951.21 / $4,365.16
| Facility | | $2,041.74 | $2,951.21 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,818.38 / $10,000.00
| Facility | | $1,995.26 | $2,818.38 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,818.38 / $10,000.00
| Professional | | $1,995.26 | $2,818.38 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $10,471.29 / $21,379.62
| Facility | | $6,456.54 | $10,471.29 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,691.53 / $4,265.80
| Professional | | $1,737.80 | $2,691.53 | $4,265.80 |