- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,715.35 / $5,623.41
| Professional | | $2,691.53 | $3,715.35 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $3,548.13
| Professional | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $13,803.84 / $16,982.44
| Professional | | $6,309.57 | $13,803.84 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $6,165.95 / $8,317.64
| Facility | | $5,011.87 | $6,165.95 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,606.93 / $8,912.51
| Professional | | $6,025.60 | $6,606.93 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $8,128.31 / $8,317.64
| Facility | | $6,606.93 | $8,128.31 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $8,317.64 / $8,317.64
| Professional | | $7,079.46 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $6,456.54 / $8,912.51
| Facility | | $3,715.35 | $6,456.54 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $7,079.46 / $8,709.64
| Professional | | $79.43 | $7,079.46 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $13,182.57 / $32,359.37
| Facility | | $6,918.31 | $13,182.57 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $9,332.54 / $9,332.54
| Professional | | $8,317.64 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,786.30 / $10,000.00
| Facility | | $4,073.80 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,090.30 / $5,888.44
| Professional | | $2,398.83 | $3,090.30 | $5,888.44 |