- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $3,019.95 / $4,265.80
| Facility | | $1,380.38 | $3,019.95 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,862.09 / $3,019.95
| Professional | | $1,479.11 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $7,585.78
| Facility | | $3,801.89 | $3,801.89 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $6,165.95
| Professional | | $2,041.74 | $2,041.74 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,090.30 / $3,090.30
| Facility | | $2,884.03 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $3,090.30
| Professional | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $53,703.18
| Facility | | $2,691.53 | $2,691.53 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $4,365.16
| Professional | | $1,949.84 | $1,949.84 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $6,309.57 / $14,791.08
| Facility | | $3,801.89 | $6,309.57 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,801.89 / $7,244.36
| Professional | | $2,398.83 | $3,801.89 | $7,244.36 |
- 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
- $2,238.72 / $2,398.83 / $2,818.38
| Professional | | $2,238.72 | $2,398.83 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $50,118.72 / $75,857.76
| Facility | | $6,165.95 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,630.78 / $3,630.78
| Professional | | $2,511.89 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,570.40 / $10,471.29
| Facility | | $1,412.54 | $2,570.40 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,454.71 / $6,165.95
| Professional | | $1,258.93 | $2,454.71 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,238.72 / $2,951.21
| Facility | | $2,137.96 | $2,238.72 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,398.83 / $2,818.38
| Professional | | $2,238.72 | $2,398.83 | $2,818.38 |