- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $6,025.60 / $9,549.93
| Facility | | $1,348.96 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,380.38 / $2,754.23
| Professional | | $1,148.15 | $1,380.38 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $6,606.93 / $57,543.99
| Facility | | $6,456.54 | $6,606.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Professional | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,479.11 / $2,398.83
| Professional | | $436.52 | $1,479.11 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $1,905.46
| Professional | | $1,819.70 | $1,819.70 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,513.56 / $2,398.83
| Professional | | $1,122.02 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $4,786.30 / $8,709.64
| Facility | | $1,047.13 | $4,786.30 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,380.38 / $2,884.03
| Professional | | $1,148.15 | $1,380.38 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,949.84 / $2,691.53
| Professional | | $1,445.44 | $1,949.84 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $1,230.27
| Facility | | $691.83 | $691.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,202.26 / $1,258.93
| Professional | | $691.83 | $1,202.26 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,981.07 / $10,715.19
| Facility | | $1,659.59 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,348.96 / $2,511.89
| Professional | | $1,023.29 | $1,348.96 | $2,511.89 |