- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $6,606.93 / $16,982.44
| Facility | | $2,344.23 | $6,606.93 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,737.80 / $6,309.57
| Professional | | $389.05 | $1,737.80 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $3,630.78 / $3,630.78
| Professional | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $8,128.31 / $15,848.93
| Facility | | $4,570.88 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $3,090.30 / $6,165.95
| Professional | | $630.96 | $3,090.30 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $3,548.13 / $6,606.93
| Facility | | $85.11 | $3,548.13 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,513.56 / $4,466.84
| Professional | | $398.11 | $1,513.56 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,698.24 / $1,995.26
| Facility | | $1,698.24 | $1,698.24 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,778.28 / $4,365.16
| Professional | | $416.87 | $1,778.28 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,698.24 / $5,623.41
| Professional | | $416.87 | $1,698.24 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $3,311.31 / $6,606.93
| Professional | | $371.54 | $3,311.31 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $9,772.37
| Facility | | $54.95 | $56.23 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17,782.79 / $17,782.79 / $17,782.79
| Professional | | $17,782.79 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,659.59 / $5,495.41
| Facility | | $416.87 | $1,659.59 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,659.59 / $4,168.69
| Professional | | $398.11 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $6,025.60
| Professional | | $1,230.27 | $1,230.27 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $2,398.83 / $4,365.16
| Professional | | $371.54 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $7,244.36 / $15,135.61
| Facility | | $3,890.45 | $7,244.36 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,445.44 / $4,265.80
| Professional | | $363.08 | $1,445.44 | $4,265.80 |