- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $7,943.28 / $20,892.96
| Facility | | $1,348.96 | $7,943.28 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $831.76 / $3,467.37
| Professional | | $630.96 | $831.76 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,454.40 / $19,952.62 / $40,738.03
| Facility | | $14,454.40 | $19,952.62 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,380.38 / $1,819.70
| Professional | | $977.24 | $1,380.38 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,348.96 / $2,137.96
| Professional | | $812.83 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,698.24 / $20,892.96
| Facility | | $954.99 | $1,698.24 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,548.82 / $5,888.44
| Professional | | $912.01 | $1,548.82 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $56.23
| Professional | | $32.36 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,380.38 / $1,445.44
| Facility | | $758.58 | $1,380.38 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Facility | | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,513.56 / $2,089.30
| Professional | | $977.24 | $1,513.56 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,803.84 / $20,892.96 / $40,738.03
| Facility | | $13,803.84 | $20,892.96 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,412.54 / $1,949.84
| Professional | | $977.24 | $1,412.54 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $22,908.68 / $42,657.95
| Facility | | $3,467.37 | $22,908.68 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,096.48 / $1,949.84
| Professional | | $741.31 | $1,096.48 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $851.14 / $1,288.25
| Professional | | $676.08 | $851.14 | $1,288.25 |