- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $4,897.79 / $15,488.17
| Facility | | $1,995.26 | $4,897.79 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $15,488.17 / $15,488.17
| Professional | | $3,388.44 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $489.78 / $11,748.98
| Facility | | $446.68 | $489.78 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,737.80 / $3,981.07
| Professional | | $954.99 | $1,737.80 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $5,370.32 / $6,918.31
| Facility | | $1,698.24 | $5,370.32 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,862.09 / $4,786.30
| Professional | | $1,380.38 | $1,862.09 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $4,073.80 / $7,762.47
| Facility | | $1,659.59 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,698.24 / $5,128.61
| Professional | | $1,258.93 | $1,698.24 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,570.40 / $3,162.28
| Professional | | $2,344.23 | $2,570.40 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,570.40 / $4,073.80
| Professional | | $2,089.30 | $2,570.40 | $4,073.80 |
- 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
- $11,748.98 / $17,378.01 / $17,378.01
| Professional | | $11,748.98 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,019.95 / $6,918.31
| Facility | | $1,995.26 | $3,019.95 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,511.89 / $4,677.35
| Professional | | $1,258.93 | $2,511.89 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $8,128.31 / $8,128.31
| Professional | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $2,344.23 / $2,344.23
| Facility | | $977.24 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $4,677.35
| Professional | | $977.24 | $977.24 | $4,677.35 |