- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $8,709.64 / $16,218.10
| Facility | | $3,388.44 | $8,709.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,089.30 / $16,218.10
| Professional | | $1,621.81 | $2,089.30 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $5,754.40 / $12,302.69
| Facility | | $1,148.15 | $5,754.40 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,445.44 / $4,677.35
| Professional | | $977.24 | $1,445.44 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $10,471.29 / $28,183.83
| Facility | | $85.11 | $10,471.29 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,949.84 / $5,011.87
| Professional | | $1,445.44 | $1,949.84 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $4,265.80 / $8,128.31
| Facility | | $1,698.24 | $4,265.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,698.24 / $5,754.40
| Professional | | $1,288.25 | $1,698.24 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,454.71 / $3,311.31
| Professional | | $1,949.84 | $2,454.71 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,691.53 / $4,265.80
| Professional | | $2,187.76 | $2,691.53 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $11,748.98 / $11,748.98
| Facility | | $11,748.98 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12,302.69 / $18,197.01 / $18,197.01
| Professional | | $12,302.69 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,951.21 / $6,309.57
| Facility | | $1,862.09 | $2,951.21 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,570.40 / $5,248.07
| Professional | | $1,318.26 | $2,570.40 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,454.71 / $29,512.09
| Professional | | $1,949.84 | $2,454.71 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,454.71 / $2,454.71
| Facility | | $1,023.29 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $5,370.32
| Professional | | $1,023.29 | $1,023.29 | $5,370.32 |