- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $7,244.36 / $11,748.98
| Facility | | $2,398.83 | $7,244.36 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,445.44 / $1,905.46
| Professional | | $1,148.15 | $1,445.44 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $8,912.51 / $8,912.51
| Facility | | $4,466.84 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $43.65 / $3,630.78
| Professional | | $33.11 | $43.65 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $2,818.38 / $4,897.79
| Facility | | $97.72 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,380.38 / $3,090.30
| Professional | | $1,047.13 | $1,380.38 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,951.21 / $5,888.44
| Facility | | $1,348.96 | $2,951.21 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,949.84 / $2,398.83
| Professional | | $1,778.28 | $1,949.84 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,949.84 / $3,090.30
| Professional | | $1,584.89 | $1,949.84 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $8,317.64 / $8,317.64
| Facility | | $8,317.64 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $13,182.57 / $13,182.57
| Professional | | $8,912.51 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,137.96 / $3,890.45
| Facility | | $1,202.26 | $2,137.96 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,949.84 / $2,630.27
| Professional | | $1,778.28 | $1,949.84 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,778.28 / $2,137.96
| Facility | | $741.31 | $1,778.28 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $3,548.13
| Professional | | $741.31 | $741.31 | $3,548.13 |