- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $5,370.32 / $16,595.87
| Facility | | $2,884.03 | $5,370.32 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,691.53 / $5,623.41
| Professional | | $1,584.89 | $2,691.53 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,265.80 / $5,754.40
| Facility | | $2,884.03 | $4,265.80 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,884.03 / $3,715.35
| Professional | | $2,454.71 | $2,884.03 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $6,165.95 / $7,413.10
| Facility | | $3,019.95 | $6,165.95 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,019.95 / $3,890.45
| Professional | | $1,445.44 | $3,019.95 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,630.78 / $9,772.37
| Facility | | $2,884.03 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,630.78 / $8,128.31
| Professional | | $2,884.03 | $3,630.78 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $75.86
| Professional | | $64.57 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $5,754.40
| Facility | | $2,884.03 | $2,884.03 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $3,467.37
| Professional | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,570.88 / $8,912.51
| Facility | | $2,884.03 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $3,467.37
| Professional | | $2,570.40 | $2,570.40 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,265.80 / $7,585.78
| Facility | | $3,311.31 | $4,265.80 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,884.03 / $3,715.35
| Professional | | $2,454.71 | $2,884.03 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,467.37 / $3,467.37
| Facility | | $2,884.03 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,202.26 / $3,235.94
| Professional | | $891.25 | $1,202.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,884.03 / $5,128.61
| Professional | | $1,288.25 | $2,884.03 | $5,128.61 |