- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $8,128.31 / $20,892.96
| Facility | | $1,621.81 | $8,128.31 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,096.48 / $2,137.96
| Professional | | $724.44 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,803.84 / $19,054.61 / $38,904.51
| Facility | | $13,803.84 | $19,054.61 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,621.81 / $2,238.72
| Professional | | $1,174.90 | $1,621.81 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $933.25 / $10,471.29
| Facility | | $891.25 | $933.25 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,348.96 / $2,454.71
| Professional | | $776.25 | $1,348.96 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,621.81 / $8,128.31
| Facility | | $851.14 | $1,621.81 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,548.82 / $6,606.93
| Professional | | $776.25 | $1,548.82 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $380.19
| Professional | | $32.36 | $33.11 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,548.82 / $1,621.81
| Facility | | $1,258.93 | $1,548.82 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $2,187.76
| Facility | | $1,148.15 | $1,148.15 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,659.59 / $2,238.72
| Professional | | $1,148.15 | $1,659.59 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,182.57 / $19,952.62 / $38,904.51
| Facility | | $13,182.57 | $19,952.62 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,621.81 / $2,187.76
| Professional | | $1,174.90 | $1,621.81 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $20,892.96 / $41,686.94
| Facility | | $2,951.21 | $20,892.96 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,148.15 / $2,137.96
| Professional | | $812.83 | $1,148.15 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $954.99 / $1,778.28
| Professional | | $933.25 | $954.99 | $1,778.28 |