- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,311.31 / $3,311.31
| Facility | | $2,951.21 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,398.83 / $3,548.13
| Professional | | $1,737.80 | $2,398.83 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,819.70 / $3,548.13
| Professional | | $1,737.80 | $1,819.70 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $457.09 / $5,888.44
| Facility | | $426.58 | $457.09 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $5,888.44
| Professional | | $457.09 | $457.09 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $2,238.72 / $50,118.72
| Facility | | $275.42 | $2,238.72 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,513.56 / $8,317.64
| Professional | | $1,513.56 | $1,513.56 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,981.07 / $3,981.07
| Professional | | $3,235.94 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $4,168.69
| Facility | | $3,981.07 | $3,981.07 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $5,623.41 / $6,165.95
| Professional | | $3,981.07 | $5,623.41 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $2,630.27
| Professional | | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $50,118.72 / $75,857.76
| Facility | | $851.14 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $389.05 / $3,548.13
| Facility | | $138.04 | $389.05 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $416.87 / $3,548.13
| Professional | | $109.65 | $416.87 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $4,786.30 / $5,754.40
| Facility | | $3,981.07 | $4,786.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $5,623.41 / $6,165.95
| Professional | | $3,981.07 | $5,623.41 | $6,165.95 |