- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $13,803.84 / $25,703.96
| Facility | | $5,248.07 | $13,803.84 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,630.78 / $22,387.21
| Professional | | $2,570.40 | $3,630.78 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,570.88 / $19,498.45
| Facility | | $4,073.80 | $4,570.88 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,168.69 / $7,943.28
| Professional | | $3,890.45 | $4,168.69 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,090.30 / $7,943.28
| Professional | | $2,290.87 | $3,090.30 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $6,760.83 / $12,882.50
| Facility | | $2,691.53 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,168.69 / $15,135.61
| Professional | | $2,041.74 | $4,168.69 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,265.80 / $5,754.40
| Professional | | $3,890.45 | $4,265.80 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,265.80 / $6,760.83
| Professional | | $3,467.37 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19,498.45 / $28,840.32 / $28,840.32
| Professional | | $19,498.45 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,677.35 / $10,000.00
| Facility | | $2,951.21 | $4,677.35 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $4,265.80 / $11,748.98
| Professional | | $2,290.87 | $4,265.80 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $4,365.16 / $57,543.99
| Professional | | $3,090.30 | $4,365.16 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,890.45 / $3,890.45
| Facility | | $1,621.81 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $8,128.31
| Professional | | $1,621.81 | $1,621.81 | $8,128.31 |