- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $5,623.41 / $17,782.79
| Facility | | $2,511.89 | $5,623.41 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,884.03 / $3,801.89
| Professional | | $2,344.23 | $2,884.03 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $3,890.45
| Professional | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,019.95 / $10,232.93
| Facility | | $2,511.89 | $3,019.95 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $4,677.35 / $5,623.41
| Professional | | $4,677.35 | $4,677.35 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18,620.87 / $18,620.87 / $18,620.87
| Facility | | $18,620.87 | $18,620.87 | $18,620.87 |
- 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
- $2,398.83 / $3,890.45 / $7,244.36
| Facility | | $2,398.83 | $3,890.45 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,090.30 / $4,677.35
| Professional | | $2,344.23 | $3,090.30 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,168.69 / $8,317.64
| Professional | | $3,890.45 | $4,168.69 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,801.89 / $7,244.36
| Facility | | $2,344.23 | $3,801.89 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $4,073.80 / $7,244.36
| Professional | | $3,715.35 | $4,073.80 | $7,244.36 |
- 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 / $2,754.23
| Professional | | $1,621.81 | $1,621.81 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,995.26 / $3,890.45
| Professional | | $588.84 | $1,995.26 | $3,890.45 |