- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $6,025.60 / $9,549.93
| Facility | | $1,412.54 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,778.28 / $3,890.45
| Professional | | $1,412.54 | $1,778.28 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $10,000.00 / $57,543.99
| Facility | | $9,549.93 | $10,000.00 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,454.71 / $2,884.03
| Professional | | $1,659.59 | $2,454.71 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $2,041.74 / $3,235.94
| Professional | | $436.52 | $2,041.74 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,570.40
| Professional | | $2,398.83 | $2,398.83 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,041.74 / $2,884.03
| Professional | | $1,548.82 | $2,041.74 | $2,884.03 |
- 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
- $1,380.38 / $1,737.80 / $2,630.27
| Professional | | $1,380.38 | $1,737.80 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $2,630.27 / $3,090.30
| Professional | | $6.03 | $2,630.27 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,737.80 / $1,737.80
| Facility | | $1,659.59 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,659.59 / $1,737.80
| Professional | | $1,621.81 | $1,659.59 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $5,754.40 / $19,054.61
| Facility | | $2,344.23 | $5,754.40 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,862.09 / $3,311.31
| Professional | | $1,380.38 | $1,862.09 | $3,311.31 |