- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $6,760.83
| Facility | | $2,884.03 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,137.96 / $3,715.35
| Professional | | $1,737.80 | $2,137.96 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $4,168.69 / $4,168.69
| Facility | | $3,715.35 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $4,786.30
| Professional | | $3,715.35 | $3,715.35 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $2,511.89
| Professional | | $1,819.70 | $1,819.70 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $5,248.07 / $12,022.64
| Facility | | $2,454.71 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $5,011.87 / $8,511.38
| Professional | | $2,454.71 | $5,011.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $3,235.94 / $3,630.78
| Professional | | $75.86 | $3,235.94 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,168.69 / $4,265.80
| Facility | | $3,388.44 | $4,168.69 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $4,265.80 / $4,265.80
| Professional | | $3,548.13 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $6,309.57 / $8,511.38
| Facility | | $3,715.35 | $6,309.57 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $4,168.69
| Professional | | $3,548.13 | $3,548.13 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $4,786.30
| Professional | | $3,715.35 | $3,715.35 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $4,786.30 / $5,754.40
| Facility | | $1,737.80 | $4,786.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,041.74 / $3,388.44
| Professional | | $1,659.59 | $2,041.74 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,715.35 / $6,456.54
| Professional | | $1,621.81 | $3,715.35 | $6,456.54 |