- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $5,754.40 / $8,511.38
| Facility | | $1,047.13 | $5,754.40 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,348.96 / $2,238.72
| Professional | | $1,122.02 | $1,348.96 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20,417.38 / $21,379.62 / $57,543.99
| Facility | | $20,417.38 | $21,379.62 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,995.26 / $2,454.71
| Professional | | $1,778.28 | $1,995.26 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $794.33 / $2,137.96
| Facility | | $489.78 | $794.33 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,412.54 / $2,570.40
| Professional | | $851.14 | $1,412.54 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,737.80 / $2,398.83
| Professional | | $1,288.25 | $1,737.80 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,318.26 / $2,041.74
| Professional | | $1,096.48 | $1,318.26 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $3,981.07 / $8,317.64
| Facility | | $831.76 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,318.26 / $2,187.76
| Professional | | $1,071.52 | $1,318.26 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,238.72 / $2,754.23
| Professional | | $1,202.26 | $2,238.72 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,230.27
| Facility | | $1,023.29 | $1,023.29 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,230.27 / $1,288.25
| Professional | | $416.87 | $1,230.27 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,290.87 / $6,309.57
| Facility | | $398.11 | $2,290.87 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,380.38 / $2,398.83
| Professional | | $1,000.00 | $1,380.38 | $2,398.83 |