- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $5,128.61 / $15,135.61
| Facility | | $630.96 | $5,128.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,090.30 / $5,495.41
| Professional | | $1,000.00 | $3,090.30 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $5,370.32 / $9,549.93
| Facility | | $5,370.32 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $3,715.35 / $5,623.41
| Professional | | $1,949.84 | $3,715.35 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $7,244.36 / $8,709.64
| Professional | | $3,630.78 | $7,244.36 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,311.31 / $4,897.79
| Facility | | $3,235.94 | $3,311.31 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,801.89 / $4,897.79
| Professional | | $3,235.94 | $3,801.89 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $6,760.83
| Facility | | $3,311.31 | $3,311.31 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $3,981.07
| Professional | | $3,311.31 | $3,311.31 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $4,570.88 / $8,709.64
| Facility | | $3,019.95 | $4,570.88 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $3,630.78 / $4,786.30
| Professional | | $1,949.84 | $3,630.78 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $10,000.00 / $13,182.57
| Facility | | $5,011.87 | $10,000.00 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,818.38 / $3,981.07
| Professional | | $2,511.89 | $2,818.38 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $3,981.07 / $5,370.32
| Facility | | $1,479.11 | $3,981.07 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $3,981.07
| Professional | | $1,380.38 | $1,380.38 | $3,981.07 |