- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $7,943.28 / $25,703.96
| Facility | | $3,630.78 | $7,943.28 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,388.44 / $5,888.44
| Professional | | $2,398.83 | $3,388.44 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,370.32 / $7,244.36
| Facility | | $3,630.78 | $5,370.32 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,630.78 / $4,677.35
| Professional | | $3,090.30 | $3,630.78 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $7,943.28 / $9,332.54
| Facility | | $3,715.35 | $7,943.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,801.89 / $4,897.79
| Professional | | $1,778.28 | $3,801.89 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,466.84 / $16,218.10
| Facility | | $3,630.78 | $4,466.84 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,897.79 / $10,964.78
| Professional | | $3,630.78 | $4,897.79 | $10,964.78 |
- 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
- $3,630.78 / $3,630.78 / $3,981.07
| Facility | | $3,630.78 | $3,630.78 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,754.40 / $11,220.18
| Facility | | $3,630.78 | $5,754.40 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $4,365.16
| Professional | | $3,235.94 | $3,235.94 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $5,370.32 / $9,549.93
| Facility | | $4,168.69 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,630.78 / $4,677.35
| Professional | | $3,090.30 | $3,630.78 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,365.16 / $4,365.16
| Facility | | $3,630.78 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,513.56 / $4,073.80
| Professional | | $1,513.56 | $1,513.56 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,630.78 / $6,456.54
| Professional | | $1,621.81 | $3,630.78 | $6,456.54 |