- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $5,011.87 / $15,848.93
| Facility | | $1,513.56 | $5,011.87 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,380.38 / $2,398.83
| Professional | | $1,148.15 | $1,380.38 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $11,220.18 / $15,135.61
| Facility | | $6,760.83 | $11,220.18 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,659.59 / $2,511.89
| Professional | | $1,230.27 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,412.54 / $2,570.40
| Professional | | $933.25 | $1,412.54 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $524.81 / $2,187.76
| Facility | | $489.78 | $524.81 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,479.11 / $2,454.71
| Professional | | $1,047.13 | $1,479.11 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,380.38 / $2,290.87
| Professional | | $1,148.15 | $1,380.38 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,584.89 / $2,691.53
| Professional | | $1,513.56 | $1,584.89 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,659.59 / $2,570.40
| Facility | | $1,230.27 | $1,659.59 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $2,344.23
| Professional | | $1,348.96 | $1,348.96 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,513.56 / $5,495.41
| Facility | | $1,202.26 | $1,513.56 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,513.56 / $5,495.41
| Professional | | $1,202.26 | $1,513.56 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $9,549.93 / $21,379.62
| Facility | | $2,238.72 | $9,549.93 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,445.44 / $2,454.71
| Professional | | $1,000.00 | $1,445.44 | $2,454.71 |