- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,413.10 / $7,413.10
| Facility | | $4,073.80 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $4,466.84 / $12,022.64
| Professional | | $2,691.53 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $10,964.78
| Professional | | $851.14 | $851.14 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $8,709.64 / $13,803.84
| Facility | | $7,413.10 | $8,709.64 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $4,677.35 / $8,511.38
| Professional | | $3,090.30 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $12,302.69 / $16,982.44
| Facility | | $3,467.37 | $12,302.69 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16,218.10 / $16,218.10 / $18,197.01
| Professional | | $16,218.10 | $16,218.10 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,630.78 / $9,549.93
| Facility | | $2,951.21 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,621.81 / $8,317.64
| Professional | | $1,230.27 | $1,621.81 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $1,348.96
| Professional | | $50.12 | $64.57 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,235.94 / $7,762.47
| Facility | | $2,951.21 | $3,235.94 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $4,365.16 / $7,585.78
| Professional | | $2,691.53 | $4,365.16 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $6,456.54 / $8,912.51
| Professional | | $4,365.16 | $6,456.54 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $12,882.50 / $12,882.50
| Facility | | $5,370.32 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $13,489.63 / $13,489.63
| Professional | | $3,235.94 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $5,754.40 / $5,754.40
| Professional | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $14,791.08 / $20,417.38
| Professional | | $7,943.28 | $14,791.08 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $2,187.76 / $5,888.44
| Facility | | $977.24 | $2,187.76 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,621.81 / $4,073.80
| Professional | | $1,148.15 | $1,621.81 | $4,073.80 |