- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $3,715.35 / $12,882.50
| Facility | | $1,096.48 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,187.76 / $3,630.78
| Professional | | $1,862.09 | $2,187.76 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,630.78 / $12,022.64
| Facility | | $2,187.76 | $3,630.78 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,344.23 / $3,235.94
| Professional | | $1,905.46 | $2,344.23 | $3,235.94 |
- 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
- $1,949.84 / $2,691.53 / $4,365.16
| Professional | | $1,949.84 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $26,302.68
| Facility | | $54.95 | $56.23 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14,791.08 / $17,782.79 / $17,782.79
| Professional | | $14,791.08 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,818.38 / $5,370.32
| Facility | | $1,698.24 | $2,818.38 | $5,370.32 |
- 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 / $263.03 / $1,778.28
| Professional | | $32.36 | $263.03 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $1,659.59
| Professional | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,754.23 / $4,570.88
| Facility | | $1,905.46 | $2,754.23 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,691.53 / $4,365.16
| Professional | | $1,905.46 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $7,079.46 / $14,791.08
| Facility | | $2,754.23 | $7,079.46 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,290.87 / $3,548.13
| Professional | | $1,737.80 | $2,290.87 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,819.70 / $1,949.84
| Professional | | $1,778.28 | $1,819.70 | $1,949.84 |