- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,630.78 / $9,549.93
| Facility | | $1,659.59 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,621.81 / $2,398.83
| Professional | | $1,288.25 | $1,621.81 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $12,302.69 / $17,782.79
| Facility | | $9,772.37 | $12,302.69 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,659.59 / $2,344.23
| Professional | | $1,258.93 | $1,659.59 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,445.44 / $2,238.72
| Professional | | $1,318.26 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,819.70 / $2,511.89
| Professional | | $1,348.96 | $1,819.70 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,445.44 / $1,778.28
| Professional | | $1,202.26 | $1,445.44 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,511.89 / $3,090.30
| Professional | | $1,995.26 | $2,511.89 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,995.26 / $2,818.38
| Facility | | $1,412.54 | $1,995.26 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,862.09 / $10,000.00
| Facility | | $1,230.27 | $1,862.09 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,862.09 / $10,000.00
| Professional | | $1,230.27 | $1,862.09 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,311.31 / $6,309.57
| Facility | | $1,621.81 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,905.46 / $2,884.03
| Professional | | $1,202.26 | $1,905.46 | $2,884.03 |