- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,454.71 / $4,073.80
| Professional | | $2,089.30 | $2,454.71 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $4,897.79 / $8,128.31
| Facility | | $4,897.79 | $4,897.79 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,570.88 / $5,495.41
| Professional | | $4,168.69 | $4,570.88 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $11,220.18 / $23,988.33
| Facility | | $2,884.03 | $11,220.18 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $7,079.46 / $9,332.54
| Professional | | $2,089.30 | $7,079.46 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,981.07 / $6,025.60
| Facility | | $2,398.83 | $3,981.07 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $5,888.44 / $7,244.36
| Professional | | $4,365.16 | $5,888.44 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,786.30 / $22,387.21
| Facility | | $2,454.71 | $4,786.30 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,090.30 / $5,495.41
| Professional | | $2,187.76 | $3,090.30 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $3,235.94
| Professional | | $54.95 | $70.79 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $5,495.41 / $9,772.37
| Professional | | $3,467.37 | $5,495.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $7,413.10 / $13,489.63
| Professional | | $4,897.79 | $7,413.10 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $9,772.37 / $22,387.21
| Facility | | $2,884.03 | $9,772.37 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $4,168.69 / $24,547.09
| Professional | | $2,089.30 | $4,168.69 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,235.94 / $4,897.79
| Facility | | $2,570.40 | $3,235.94 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,398.83 / $3,981.07
| Professional | | $1,862.09 | $2,398.83 | $3,981.07 |