- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,466.84 / $12,882.50
| Facility | | $3,311.31 | $4,466.84 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,754.23 / $4,786.30
| Professional | | $724.44 | $2,754.23 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $8,511.38
| Facility | | $4,786.30 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,311.31 / $4,897.79
| Professional | | $1,698.24 | $3,311.31 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $6,309.57 / $7,762.47
| Professional | | $3,235.94 | $6,309.57 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,951.21 / $4,365.16
| Facility | | $2,818.38 | $2,951.21 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,388.44 / $4,365.16
| Professional | | $2,818.38 | $3,388.44 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $5,888.44
| Facility | | $2,951.21 | $2,951.21 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,951.21 / $3,467.37
| Professional | | $2,630.27 | $2,951.21 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,073.80 / $7,762.47
| Facility | | $2,630.27 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,235.94 / $4,168.69
| Professional | | $1,698.24 | $3,235.94 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $8,709.64 / $11,481.54
| Facility | | $4,365.16 | $8,709.64 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,754.23 / $3,467.37
| Professional | | $2,187.76 | $2,754.23 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $3,467.37 / $4,677.35
| Facility | | $1,318.26 | $3,467.37 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $3,467.37
| Professional | | $1,230.27 | $1,230.27 | $3,467.37 |