- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $5,754.40 / $5,754.40
| Facility | | $2,511.89 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,659.59 / $2,511.89
| Professional | | $1,445.44 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $12.30 / $6,918.31
| Professional | | $10.47 | $12.30 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $6,606.93 / $10,715.19
| Facility | | $5,754.40 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,090.30 / $6,456.54
| Professional | | $2,398.83 | $3,090.30 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $8,317.64 / $12,022.64
| Facility | | $1,621.81 | $8,317.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,511.89 / $9,772.37
| Facility | | $1,445.44 | $2,511.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,258.93 / $3,715.35
| Professional | | $1,047.13 | $1,258.93 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,511.89 / $2,511.89
| Facility | | $2,238.72 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,089.30 / $4,168.69
| Professional | | $1,548.82 | $2,089.30 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $4,897.79 / $6,760.83
| Professional | | $2,754.23 | $4,897.79 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $9,772.37
| Facility | | $4,168.69 | $4,168.69 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $4,466.84
| Professional | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $11,220.18 / $11,220.18
| Professional | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,659.59 / $2,511.89
| Facility | | $1,047.13 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,258.93 / $3,715.35
| Professional | | $870.96 | $1,258.93 | $3,715.35 |