- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $3,715.35 / $12,882.50
| Facility | | $1,122.02 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,187.76 / $3,630.78
| Professional | | $1,819.70 | $2,187.76 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,890.45 / $22,387.21
| Facility | | $2,187.76 | $3,890.45 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,398.83 / $3,311.31
| Professional | | $1,905.46 | $2,398.83 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $1,819.70 / $1,862.09
| Facility | | $79.43 | $1,819.70 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,754.23 / $4,265.80
| Professional | | $1,995.26 | $2,754.23 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $21,379.62
| Facility | | $54.95 | $56.23 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20,417.38 / $20,417.38 / $20,417.38
| Professional | | $20,417.38 | $20,417.38 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,691.53 / $5,248.07
| Facility | | $1,778.28 | $2,691.53 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,630.27 / $4,265.80
| Professional | | $1,905.46 | $2,630.27 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $269.15 / $1,778.28
| Professional | | $32.36 | $269.15 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $2,691.53
| Professional | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,630.27 / $4,677.35
| Facility | | $1,905.46 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,754.23 / $4,265.80
| Professional | | $1,949.84 | $2,754.23 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $6,165.95 / $11,481.54
| Facility | | $2,238.72 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,238.72 / $3,467.37
| Professional | | $1,659.59 | $2,238.72 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,819.70 / $1,905.46
| Professional | | $1,778.28 | $1,819.70 | $1,905.46 |