- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,897.79 / $9,549.93
| Facility | | $3,235.94 | $4,897.79 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,570.88 / $7,079.46
| Professional | | $3,890.45 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $18,620.87 / $25,118.86
| Facility | | $8,511.38 | $18,620.87 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $5,370.32 / $8,317.64
| Professional | | $3,981.07 | $5,370.32 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,570.88 / $8,317.64
| Professional | | $4,168.69 | $4,570.88 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $524.81 / $7,244.36
| Facility | | $489.78 | $524.81 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,897.79 / $8,128.31
| Professional | | $2,041.74 | $4,897.79 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $4,570.88 / $7,585.78
| Professional | | $3,801.89 | $4,570.88 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $4,677.35 / $6,456.54
| Professional | | $3,090.30 | $4,677.35 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,370.32 / $8,511.38
| Facility | | $3,630.78 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $4,677.35
| Professional | | $3,090.30 | $3,090.30 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $5,011.87 / $9,332.54
| Facility | | $2,454.71 | $5,011.87 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $5,011.87 / $9,332.54
| Professional | | $2,454.71 | $5,011.87 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $3,162.28 / $5,754.40
| Facility | | $512.86 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,570.88 / $8,317.64
| Professional | | $2,630.27 | $4,570.88 | $8,317.64 |