- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $6,918.31 / $11,748.98
| Facility | | $3,890.45 | $6,918.31 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,311.31 / $7,079.46
| Professional | | $2,089.30 | $3,311.31 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $10,000.00
| Facility | | $3,890.45 | $3,890.45 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $7,585.78
| Professional | | $1,548.82 | $1,548.82 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,890.45 / $3,890.45
| Facility | | $2,344.23 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,890.45 / $3,890.45
| Professional | | $2,818.38 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $8,317.64 / $13,803.84
| Facility | | $3,801.89 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,786.30 / $18,620.87
| Professional | | $2,344.23 | $4,786.30 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,677.35 / $10,715.19
| Facility | | $2,818.38 | $4,677.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,467.37 / $7,413.10
| Professional | | $2,691.53 | $3,467.37 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,801.89 / $6,918.31
| Professional | | $3,090.30 | $3,801.89 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $7,244.36 / $50,118.72
| Facility | | $5,011.87 | $7,244.36 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $3,981.07
| Professional | | $3,890.45 | $3,890.45 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,890.45 / $4,786.30
| Facility | | $3,467.37 | $3,890.45 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,884.03 / $7,413.10
| Professional | | $1,621.81 | $2,884.03 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,073.80 / $5,011.87
| Facility | | $3,311.31 | $4,073.80 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,890.45 / $9,332.54
| Professional | | $3,311.31 | $3,890.45 | $9,332.54 |