- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,691.53 / $20,892.96
| Facility | | $1,995.26 | $2,691.53 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,230.27 / $2,630.27
| Professional | | $933.25 | $1,230.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $11,220.18
| Facility | | $6,309.57 | $6,309.57 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,041.74 / $2,691.53
| Professional | | $1,445.44 | $2,041.74 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,995.26 / $3,162.28
| Professional | | $1,230.27 | $1,995.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,137.96 / $2,691.53
| Facility | | $1,288.25 | $2,137.96 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,137.96 / $2,691.53
| Professional | | $1,348.96 | $2,137.96 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $64.57
| Professional | | $32.36 | $33.11 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,041.74 / $2,089.30
| Facility | | $1,230.27 | $2,041.74 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,238.72 / $3,090.30
| Professional | | $1,445.44 | $2,238.72 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,089.30 / $2,884.03
| Professional | | $1,445.44 | $2,089.30 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,388.44 / $6,165.95
| Facility | | $2,754.23 | $3,388.44 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,621.81 / $2,951.21
| Professional | | $1,096.48 | $1,621.81 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,258.93 / $1,905.46
| Professional | | $1,000.00 | $1,258.93 | $1,905.46 |