- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,630.78 / $10,964.78
| Facility | | $1,819.70 | $3,630.78 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,698.24 / $4,786.30
| Professional | | $1,318.26 | $1,698.24 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,762.47 / $13,803.84
| Facility | | $4,073.80 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,548.82 / $3,890.45
| Professional | | $1,202.26 | $1,548.82 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $37,153.52
| Facility | | $1,995.26 | $1,995.26 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $1,995.26
| Professional | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $5,754.40 / $53,703.18
| Facility | | $34.67 | $5,754.40 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,754.23 / $7,079.46
| Professional | | $1,288.25 | $2,754.23 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,995.26 / $5,370.32
| Facility | | $1,659.59 | $1,995.26 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,995.26 / $2,884.03
| Professional | | $1,479.11 | $1,995.26 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,737.80 / $2,951.21
| Professional | | $1,202.26 | $1,737.80 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $50,118.72 / $75,857.76
| Facility | | $1,584.89 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,905.46 / $3,090.30
| Professional | | $398.11 | $1,905.46 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $4,073.80 / $9,120.11
| Facility | | $1,479.11 | $4,073.80 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,949.84 / $5,011.87
| Professional | | $1,230.27 | $1,949.84 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,513.56 / $5,128.61
| Facility | | $1,148.15 | $1,513.56 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,737.80 / $4,570.88
| Professional | | $1,148.15 | $1,737.80 | $4,570.88 |