- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $7,943.28 / $20,892.96
| Facility | | $2,290.87 | $7,943.28 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,445.44 / $3,981.07
| Professional | | $977.24 | $1,445.44 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $10,232.93 / $20,892.96
| Facility | | $7,244.36 | $10,232.93 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,454.71 / $3,715.35
| Professional | | $1,659.59 | $2,454.71 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $3,801.89
| Facility | | $741.31 | $741.31 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,905.46 / $3,801.89
| Professional | | $1,047.13 | $1,905.46 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,137.96 / $4,570.88
| Facility | | $1,412.54 | $2,137.96 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,089.30 / $3,467.37
| Professional | | $1,412.54 | $2,089.30 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $501.19
| Professional | | $32.36 | $33.11 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,238.72 / $2,398.83
| Facility | | $1,412.54 | $2,238.72 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,659.59
| Facility | | $1,621.81 | $1,621.81 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,630.27 / $3,467.37
| Professional | | $1,659.59 | $2,630.27 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $10,715.19 / $20,892.96
| Facility | | $7,079.46 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,511.89 / $3,715.35
| Professional | | $1,659.59 | $2,511.89 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $11,220.18 / $21,877.62
| Facility | | $1,698.24 | $11,220.18 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,621.81 / $3,162.28
| Professional | | $1,202.26 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,445.44 / $2,238.72
| Professional | | $162.18 | $1,445.44 | $2,238.72 |