- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,162.28 / $4,786.30
| Professional | | $2,398.83 | $3,162.28 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $6,456.54 / $10,715.19
| Facility | | $6,456.54 | $6,456.54 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $6,025.60 / $7,244.36
| Professional | | $5,754.40 | $6,025.60 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $14,791.08 / $31,622.78
| Facility | | $4,073.80 | $14,791.08 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $9,120.11 / $12,022.64
| Professional | | $2,951.21 | $9,120.11 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $5,128.61 / $7,943.28
| Facility | | $3,090.30 | $5,128.61 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,309.57 / $7,585.78
| Professional | | $3,630.78 | $6,309.57 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $6,309.57 / $28,840.32
| Facility | | $3,162.28 | $6,309.57 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,801.89 / $7,079.46
| Professional | | $2,691.53 | $3,801.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $3,630.78
| Professional | | $54.95 | $70.79 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $7,244.36 / $12,589.25
| Professional | | $4,570.88 | $7,244.36 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $9,549.93 / $16,595.87
| Professional | | $6,456.54 | $9,549.93 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $12,882.50 / $33,884.42
| Facility | | $4,073.80 | $12,882.50 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $5,888.44 / $41,686.94
| Professional | | $2,951.21 | $5,888.44 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,981.07 / $6,456.54
| Facility | | $3,548.13 | $3,981.07 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,162.28 / $5,248.07
| Professional | | $2,238.72 | $3,162.28 | $5,248.07 |