- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,128.61 / $5,754.40
| Facility | | $5,011.87 | $5,128.61 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,715.35 / $5,754.40
| Professional | | $2,754.23 | $3,715.35 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $7,413.10
| Facility | | $4,466.84 | $4,466.84 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $7,943.28 / $10,000.00
| Professional | | $4,466.84 | $7,943.28 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $7,244.36 / $8,709.64
| Professional | | $6,309.57 | $7,244.36 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $8,709.64 / $33,884.42
| Facility | | $4,570.88 | $8,709.64 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,786.30 / $10,964.78
| Professional | | $3,235.94 | $4,786.30 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $7,585.78 / $9,772.37
| Professional | | $7,244.36 | $7,585.78 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $10,964.78 / $10,964.78
| Professional | | $7,413.10 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $6,760.83 / $17,378.01
| Facility | | $3,235.94 | $6,760.83 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,548.13 / $6,309.57
| Professional | | $3,235.94 | $3,548.13 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $6,456.54 / $6,456.54
| Professional | | $5,128.61 | $6,456.54 | $6,456.54 |