- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,187.76 / $3,715.35
| Professional | | $1,862.09 | $2,187.76 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $7,413.10
| Facility | | $4,466.84 | $4,466.84 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $4,168.69 / $4,897.79
| Professional | | $3,715.35 | $4,168.69 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $10,232.93 / $21,877.62
| Facility | | $2,454.71 | $10,232.93 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $6,309.57 / $8,511.38
| Professional | | $1,778.28 | $6,309.57 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,630.78 / $5,495.41
| Facility | | $2,187.76 | $3,630.78 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $4,265.80 / $5,370.32
| Professional | | $2,511.89 | $4,265.80 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $4,365.16 / $20,417.38
| Facility | | $2,187.76 | $4,365.16 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,818.38 / $4,897.79
| Professional | | $1,995.26 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $2,884.03
| Professional | | $54.95 | $70.79 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $7,079.46 / $7,079.46
| Facility | | $7,079.46 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $5,011.87 / $8,709.64
| Professional | | $3,162.28 | $5,011.87 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $6,760.83 / $12,302.69
| Professional | | $4,466.84 | $6,760.83 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $8,912.51 / $20,417.38
| Facility | | $2,454.71 | $8,912.51 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,548.13 / $21,877.62
| Professional | | $1,778.28 | $3,548.13 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,951.21 / $4,466.84
| Facility | | $2,344.23 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,187.76 / $3,630.78
| Professional | | $1,698.24 | $2,187.76 | $3,630.78 |