- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,548.13 / $5,011.87
| Facility | | $1,621.81 | $3,548.13 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,187.76 / $3,548.13
| Professional | | $1,698.24 | $2,187.76 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $8,912.51
| Facility | | $4,466.84 | $4,466.84 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $7,585.78
| Professional | | $2,754.23 | $2,754.23 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,630.78 / $3,630.78
| Facility | | $3,388.44 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $3,630.78 / $3,630.78
| Professional | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $53,703.18
| Facility | | $2,511.89 | $2,511.89 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $5,248.07
| Professional | | $1,819.70 | $1,819.70 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $7,413.10 / $16,982.44
| Facility | | $4,466.84 | $7,413.10 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,466.84 / $8,511.38
| Professional | | $2,818.38 | $4,466.84 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $2,951.21
| Facility | | $2,818.38 | $2,818.38 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,818.38 / $2,818.38
| Professional | | $2,630.27 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $50,118.72 / $75,857.76
| Facility | | $6,025.60 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,265.80 / $4,265.80
| Professional | | $2,884.03 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,019.95 / $12,302.69
| Facility | | $1,659.59 | $3,019.95 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,884.03 / $7,413.10
| Professional | | $1,445.44 | $2,884.03 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,754.23 / $2,951.21
| Facility | | $2,630.27 | $2,754.23 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,818.38 / $2,818.38
| Professional | | $2,630.27 | $2,818.38 | $2,818.38 |