- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,311.31 / $20,892.96
| Facility | | $2,344.23 | $3,311.31 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,513.56 / $3,090.30
| Professional | | $1,096.48 | $1,513.56 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,398.83 / $3,388.44
| Professional | | $1,698.24 | $2,398.83 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,995.26 / $2,290.87
| Facility | | $707.95 | $1,995.26 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,041.74 / $3,715.35
| Professional | | $1,202.26 | $2,041.74 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,905.46 / $3,019.95
| Facility | | $1,230.27 | $1,905.46 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,949.84 / $3,090.30
| Professional | | $1,230.27 | $1,949.84 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $79.43
| Professional | | $32.36 | $33.11 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,398.83 / $2,511.89
| Facility | | $1,548.82 | $2,398.83 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $1,698.24
| Facility | | $1,659.59 | $1,659.59 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,511.89 / $3,235.94
| Professional | | $1,698.24 | $2,511.89 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,398.83 / $3,388.44
| Professional | | $1,698.24 | $2,398.83 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $7,244.36 / $13,182.57
| Facility | | $6,025.60 | $7,244.36 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,778.28 / $3,235.94
| Professional | | $1,288.25 | $1,778.28 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,288.25 / $2,290.87
| Professional | | $1,230.27 | $1,288.25 | $2,290.87 |