- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $15,848.93 / $25,703.96
| Facility | | $5,248.07 | $15,848.93 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,162.28 / $4,073.80
| Professional | | $2,398.83 | $3,162.28 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $19,498.45 / $19,498.45
| Facility | | $9,772.37 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,380.38 / $2,570.40
| Professional | | $1,148.15 | $1,380.38 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $7,413.10 / $10,964.78
| Facility | | $2,818.38 | $7,413.10 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,019.95 / $6,760.83
| Professional | | $2,290.87 | $3,019.95 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $5,623.41 / $12,589.25
| Facility | | $2,691.53 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,265.80 / $5,248.07
| Professional | | $3,890.45 | $4,265.80 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,265.80 / $6,760.83
| Professional | | $3,467.37 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19,498.45 / $28,840.32 / $28,840.32
| Professional | | $19,498.45 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,677.35 / $8,912.51
| Facility | | $2,630.27 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,265.80 / $5,754.40
| Professional | | $3,890.45 | $4,265.80 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,890.45 / $4,677.35
| Facility | | $1,621.81 | $3,890.45 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $7,762.47
| Professional | | $1,621.81 | $1,621.81 | $7,762.47 |