- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $10,964.78 / $17,782.79
| Facility | | $3,630.78 | $10,964.78 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,187.76 / $2,818.38
| Professional | | $1,737.80 | $2,187.76 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $13,182.57 / $13,489.63
| Facility | | $6,606.93 | $13,182.57 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $269.15 / $5,370.32
| Professional | | $208.93 | $269.15 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $4,168.69 / $7,244.36
| Facility | | $97.72 | $4,168.69 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,041.74 / $4,570.88
| Professional | | $1,548.82 | $2,041.74 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $4,466.84 / $8,912.51
| Facility | | $1,995.26 | $4,466.84 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,884.03 / $3,548.13
| Professional | | $2,630.27 | $2,884.03 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,884.03 / $4,677.35
| Professional | | $2,398.83 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13,182.57 / $19,952.62 / $19,952.62
| Professional | | $13,182.57 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,162.28 / $5,888.44
| Facility | | $1,778.28 | $3,162.28 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,884.03 / $3,981.07
| Professional | | $2,630.27 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,630.27 / $3,162.28
| Facility | | $1,122.02 | $2,630.27 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $5,248.07
| Professional | | $1,122.02 | $1,122.02 | $5,248.07 |