- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $9,549.93 / $22,387.21
| Facility | | $3,715.35 | $9,549.93 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $6,456.54 / $11,481.54
| Professional | | $4,365.16 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $11,481.54 / $17,782.79
| Facility | | $6,456.54 | $11,481.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $11,748.98 / $33,113.11
| Professional | | $5,495.41 | $11,748.98 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $1,621.81 / $15,848.93
| Facility | | $83.18 | $1,621.81 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,202.26 / $2,398.83
| Professional | | $870.96 | $1,202.26 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $891.25 / $15,488.17
| Professional | | $724.44 | $891.25 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $11,748.98 / $12,302.69
| Professional | | $11,748.98 | $11,748.98 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,000.00 / $1,698.24
| Professional | | $831.76 | $1,000.00 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47,863.01 / $47,863.01 / $47,863.01
| Facility | | $47,863.01 | $47,863.01 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47,863.01 / $47,863.01 / $47,863.01
| Professional | | $47,863.01 | $47,863.01 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,445.44 / $13,489.63
| Facility | | $933.25 | $1,445.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $933.25 / $1,621.81
| Professional | | $912.01 | $933.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $870.96 / $1,071.52
| Professional | | $776.25 | $870.96 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $17,378.01 / $37,153.52
| Facility | | $9,549.93 | $17,378.01 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $12,022.64 / $22,387.21
| Professional | | $7,762.47 | $12,022.64 | $22,387.21 |