- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,890.45 / $9,549.93
| Facility | | $2,630.27 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,398.83 / $3,801.89
| Professional | | $1,995.26 | $2,398.83 | $3,801.89 |
- 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
- $2,137.96 / $2,884.03 / $4,365.16
| Professional | | $2,137.96 | $2,884.03 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,398.83 / $4,365.16
| Professional | | $2,187.76 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $524.81 / $3,801.89
| Facility | | $489.78 | $524.81 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,630.27 / $4,265.80
| Professional | | $1,778.28 | $2,630.27 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,398.83 / $3,981.07
| Professional | | $1,995.26 | $2,398.83 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,162.28 / $3,715.35
| Professional | | $2,951.21 | $3,162.28 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,951.21 / $4,466.84
| Facility | | $2,187.76 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $1,995.26
| Professional | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,630.27 / $5,011.87
| Facility | | $2,187.76 | $2,630.27 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,630.27 / $5,011.87
| Professional | | $2,187.76 | $2,630.27 | $5,011.87 |
- 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
- $1,737.80 / $2,570.40 / $4,365.16
| Professional | | $1,737.80 | $2,570.40 | $4,365.16 |