- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,801.89 / $5,370.32
| Facility | | $1,737.80 | $3,801.89 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,344.23 / $3,801.89
| Professional | | $1,819.70 | $2,344.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $9,549.93
| Facility | | $4,786.30 | $4,786.30 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $7,762.47
| Professional | | $2,570.40 | $2,570.40 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $3,890.45 / $3,890.45
| Facility | | $3,630.78 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $3,890.45
| Professional | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $53,703.18
| Facility | | $3,235.94 | $3,235.94 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $6,025.60
| Professional | | $2,398.83 | $2,398.83 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $7,943.28 / $18,197.01
| Facility | | $4,786.30 | $7,943.28 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,786.30 / $9,120.11
| Professional | | $2,951.21 | $4,786.30 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,137.96
| Facility | | $2,041.74 | $2,041.74 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,818.38 / $3,019.95
| Professional | | $2,041.74 | $2,818.38 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $50,118.72 / $75,857.76
| Facility | | $4,365.16 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $4,570.88 / $4,570.88
| Professional | | $3,090.30 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,162.28 / $12,882.50
| Facility | | $1,778.28 | $3,162.28 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $3,090.30 / $7,943.28
| Professional | | $1,548.82 | $3,090.30 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,691.53 / $2,818.38
| Facility | | $2,041.74 | $2,691.53 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,818.38 / $3,019.95
| Professional | | $2,041.74 | $2,818.38 | $3,019.95 |