- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,467.37 / $5,754.40
| Professional | | $2,884.03 | $3,467.37 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $6,918.31 / $11,481.54
| Facility | | $6,918.31 | $6,918.31 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,456.54 / $7,585.78
| Professional | | $6,309.57 | $6,456.54 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $16,218.10 / $33,884.42
| Facility | | $4,466.84 | $16,218.10 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $10,000.00 / $13,182.57
| Professional | | $3,235.94 | $10,000.00 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $5,623.41 / $8,709.64
| Facility | | $3,467.37 | $5,623.41 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $6,760.83 / $8,317.64
| Professional | | $3,890.45 | $6,760.83 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $6,760.83 / $33,884.42
| Facility | | $3,467.37 | $6,760.83 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $4,570.88 / $7,762.47
| Professional | | $3,162.28 | $4,570.88 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $85.11
| Professional | | $54.95 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $7,943.28 / $13,803.84
| Professional | | $4,897.79 | $7,943.28 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $10,471.29 / $20,417.38
| Professional | | $6,918.31 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $13,803.84 / $33,884.42
| Facility | | $4,466.84 | $13,803.84 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $6,456.54 / $42,657.95
| Professional | | $3,235.94 | $6,456.54 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,897.79 / $6,918.31
| Facility | | $3,890.45 | $4,897.79 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,388.44 / $5,623.41
| Professional | | $2,691.53 | $3,388.44 | $5,623.41 |