- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $6,165.95 / $6,165.95
| Facility | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $8,128.31 / $18,197.01
| Professional | | $6,165.95 | $8,128.31 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $15,848.93 / $17,782.79
| Facility | | $2,630.27 | $15,848.93 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $11,748.98 / $12,302.69
| Professional | | $1,737.80 | $11,748.98 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $10,000.00 / $10,715.19
| Facility | | $10,000.00 | $10,000.00 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $8,511.38 / $10,000.00
| Professional | | $1,174.90 | $8,511.38 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $8,128.31 / $13,489.63
| Facility | | $1,584.89 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $8,128.31 / $18,197.01
| Professional | | $6,165.95 | $8,128.31 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $776.25 / $7,943.28
| Professional | | $588.84 | $776.25 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $11,748.98 / $12,302.69
| Professional | | $11,748.98 | $11,748.98 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $11,220.18 / $11,220.18
| Professional | | $8,317.64 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,096.48 / $7,244.36
| Facility | | $549.54 | $1,096.48 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,677.35 / $7,413.10
| Professional | | $4,265.80 | $4,677.35 | $7,413.10 |