- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $4,786.30 / $11,481.54
| Facility | | $1,412.54 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,412.54 / $3,090.30
| Professional | | $1,230.27 | $1,412.54 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20,417.38 / $21,379.62 / $57,543.99
| Facility | | $20,417.38 | $21,379.62 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,412.54 / $2,511.89
| Professional | | $1,380.38 | $1,412.54 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,659.59 / $2,754.23
| Professional | | $1,174.90 | $1,659.59 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,995.26 / $2,570.40
| Professional | | $1,513.56 | $1,995.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,659.59 / $2,344.23
| Professional | | $1,258.93 | $1,659.59 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $23,988.33 / $45,708.82
| Facility | | $5,754.40 | $23,988.33 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,698.24 / $2,089.30
| Professional | | $1,412.54 | $1,698.24 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $3,630.78 / $8,317.64
| Facility | | $1,023.29 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,513.56 / $3,162.28
| Professional | | $1,230.27 | $1,513.56 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,089.30 / $2,951.21
| Professional | | $1,621.81 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,348.96
| Facility | | $1,096.48 | $1,096.48 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,288.25 / $1,380.38
| Professional | | $1,096.48 | $1,288.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $6,309.57 / $40,738.03
| Facility | | $3,019.95 | $6,309.57 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,584.89 / $2,884.03
| Professional | | $1,148.15 | $1,584.89 | $2,884.03 |