- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,630.78 / $9,549.93
| Facility | | $1,737.80 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,737.80 / $3,162.28
| Professional | | $1,380.38 | $1,737.80 | $3,162.28 |
- 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
- $1,621.81 / $2,454.71 / $4,168.69
| Professional | | $1,621.81 | $2,454.71 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,995.26 / $2,691.53
| Professional | | $1,698.24 | $1,995.26 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,905.46 / $3,630.78
| Professional | | $1,479.11 | $1,905.46 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,995.26 / $2,398.83
| Professional | | $1,584.89 | $1,995.26 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,570.40 / $3,890.45
| Professional | | $2,041.74 | $2,570.40 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,041.74 / $3,162.28
| Facility | | $1,548.82 | $2,041.74 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $1,949.84
| Professional | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,995.26 / $5,248.07
| Facility | | $1,445.44 | $1,995.26 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,995.26 / $5,248.07
| Professional | | $1,445.44 | $1,995.26 | $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
- $1,174.90 / $1,862.09 / $3,162.28
| Professional | | $1,174.90 | $1,862.09 | $3,162.28 |