- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $3,090.30 / $8,912.51
| Facility | | $1,096.48 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,862.09 / $3,311.31
| Professional | | $1,202.26 | $1,862.09 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $5,754.40
| Facility | | $3,235.94 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,238.72 / $3,548.13
| Professional | | $1,479.11 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $4,365.16 / $5,248.07
| Professional | | $2,187.76 | $4,365.16 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,995.26 / $3,090.30
| Facility | | $1,949.84 | $1,995.26 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,187.76 / $2,884.03
| Professional | | $1,862.09 | $2,187.76 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $3,981.07
| Facility | | $1,995.26 | $1,995.26 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $2,398.83
| Professional | | $1,995.26 | $1,995.26 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,754.23 / $5,754.40
| Facility | | $1,949.84 | $2,754.23 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $2,187.76 / $2,884.03
| Professional | | $79.43 | $2,187.76 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $6,025.60 / $7,943.28
| Facility | | $3,019.95 | $6,025.60 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,698.24 / $2,398.83
| Professional | | $1,548.82 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,019.95 / $3,235.94
| Facility | | $2,398.83 | $3,019.95 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $2,398.83
| Professional | | $831.76 | $831.76 | $2,398.83 |