- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $3,715.35 / $12,882.50
| Facility | | $1,148.15 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,445.44 / $2,187.76
| Professional | | $954.99 | $1,445.44 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $6,918.31 / $13,803.84
| Facility | | $3,801.89 | $6,918.31 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $4,365.16 / $4,365.16
| Facility | | $4,365.16 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,584.89 / $2,238.72
| Professional | | $1,148.15 | $1,584.89 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17,782.79 / $33,884.42 / $33,884.42
| Facility | | $17,782.79 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $11,481.54 / $11,481.54
| Professional | | $8,912.51 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,995.26 / $6,760.83
| Facility | | $1,000.00 | $1,995.26 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,819.70 / $2,884.03
| Professional | | $1,230.27 | $1,819.70 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,047.13
| Professional | | $32.36 | $33.11 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,513.56 / $3,019.95
| Facility | | $1,047.13 | $1,513.56 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,621.81 / $2,398.83
| Professional | | $1,148.15 | $1,621.81 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $7,079.46 / $14,454.40
| Facility | | $2,630.27 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,230.27 / $2,041.74
| Professional | | $912.01 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,348.96
| Professional | | $1,202.26 | $1,202.26 | $1,348.96 |