- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $6,025.60 / $20,892.96
| Facility | | $3,235.94 | $6,025.60 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $5,011.87 / $8,709.64
| Professional | | $4,365.16 | $5,011.87 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,388.44 / $4,168.69
| Facility | | $3,162.28 | $3,388.44 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $4,786.30
| Professional | | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $10,232.93 / $10,232.93
| Facility | | $79.43 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $5,623.41
| Professional | | $4,786.30 | $4,786.30 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45,708.82 / $45,708.82 / $45,708.82
| Facility | | $45,708.82 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52,480.75 / $74,131.02 / $74,131.02
| Professional | | $52,480.75 | $74,131.02 | $74,131.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $9,549.93 / $12,589.25
| Facility | | $4,786.30 | $9,549.93 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $5,128.61 / $10,000.00
| Professional | | $4,365.16 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $9,120.11 / $12,589.25
| Facility | | $5,128.61 | $9,120.11 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $5,623.41
| Professional | | $4,786.30 | $4,786.30 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $6,918.31 / $7,079.46
| Facility | | $3,801.89 | $6,918.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $5,754.40 / $7,079.46
| Professional | | $3,801.89 | $5,754.40 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $10,232.93 / $10,232.93
| Professional | | $5,495.41 | $10,232.93 | $10,232.93 |