- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,630.78 / $9,549.93
| Facility | | $1,995.26 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,995.26 / $3,801.89
| Professional | | $1,659.59 | $1,995.26 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,803.84 / $22,908.68 / $30,199.52
| Facility | | $13,803.84 | $22,908.68 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,754.23 / $4,786.30
| Professional | | $1,862.09 | $2,754.23 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,290.87 / $3,090.30
| Professional | | $1,905.46 | $2,290.87 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,290.87 / $4,168.69
| Professional | | $1,778.28 | $2,290.87 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,238.72 / $2,691.53
| Professional | | $1,737.80 | $2,238.72 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,090.30 / $4,365.16
| Professional | | $2,454.71 | $3,090.30 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,398.83 / $3,715.35
| Facility | | $1,819.70 | $2,398.83 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,398.83
| Professional | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,344.23 / $5,248.07
| Facility | | $1,659.59 | $2,344.23 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,344.23 / $5,248.07
| Professional | | $1,659.59 | $2,344.23 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,311.31 / $6,309.57
| Facility | | $1,584.89 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,187.76 / $3,630.78
| Professional | | $1,412.54 | $2,187.76 | $3,630.78 |