- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $6,309.57 / $10,000.00
| Facility | | $3,388.44 | $6,309.57 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $3,090.30 / $6,606.93
| Professional | | $1,949.84 | $3,090.30 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $3,630.78 / $9,332.54
| Facility | | $3,630.78 | $3,630.78 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $6,918.31
| Professional | | $1,445.44 | $1,445.44 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,630.78 / $3,630.78
| Facility | | $2,137.96 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,630.78 / $3,630.78
| Professional | | $2,630.27 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $7,762.47 / $9,332.54
| Facility | | $3,548.13 | $7,762.47 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,570.88 / $17,378.01
| Professional | | $2,238.72 | $4,570.88 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $4,677.35 / $10,000.00
| Facility | | $3,019.95 | $4,677.35 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,235.94 / $6,760.83
| Professional | | $2,511.89 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,548.13 / $6,456.54
| Professional | | $2,951.21 | $3,548.13 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $6,760.83 / $50,118.72
| Facility | | $4,677.35 | $6,760.83 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $3,630.78 / $3,715.35
| Professional | | $3,630.78 | $3,630.78 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,630.78 / $4,466.84
| Facility | | $3,235.94 | $3,630.78 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,754.23 / $7,079.46
| Professional | | $1,513.56 | $2,754.23 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,801.89 / $4,786.30
| Facility | | $2,691.53 | $3,801.89 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,630.78 / $8,511.38
| Professional | | $2,691.53 | $3,630.78 | $8,511.38 |