- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $7,244.36 / $23,988.33
| Facility | | $3,311.31 | $7,244.36 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,818.38 / $5,495.41
| Professional | | $1,862.09 | $2,818.38 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,897.79 / $6,606.93
| Facility | | $3,311.31 | $4,897.79 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,162.28 / $4,365.16
| Professional | | $2,818.38 | $3,162.28 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $7,079.46 / $8,709.64
| Facility | | $3,467.37 | $7,079.46 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,715.35 / $4,786.30
| Professional | | $1,698.24 | $3,715.35 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,168.69 / $10,232.93
| Facility | | $3,311.31 | $4,168.69 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,168.69 / $9,549.93
| Professional | | $3,311.31 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $6,760.83
| Facility | | $3,311.31 | $3,311.31 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,311.31 / $3,981.07
| Professional | | $3,019.95 | $3,311.31 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $5,370.32 / $10,232.93
| Facility | | $3,311.31 | $5,370.32 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $4,073.80
| Professional | | $3,019.95 | $3,019.95 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $5,011.87 / $8,709.64
| Facility | | $3,801.89 | $5,011.87 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,019.95 / $4,365.16
| Professional | | $2,691.53 | $3,019.95 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,981.07 / $3,981.07
| Facility | | $3,019.95 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $3,715.35
| Professional | | $1,380.38 | $1,380.38 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,737.80 / $6,025.60
| Professional | | $1,479.11 | $1,737.80 | $6,025.60 |