- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,754.23 / $3,890.45
| Facility | | $1,258.93 | $2,754.23 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,862.09 / $2,951.21
| Professional | | $1,380.38 | $1,862.09 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $6,918.31
| Facility | | $3,467.37 | $3,467.37 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,995.26 / $5,248.07
| Professional | | $1,949.84 | $1,995.26 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,818.38 / $2,818.38
| Facility | | $2,630.27 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $2,818.38
| Professional | | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $53,703.18
| Facility | | $2,570.40 | $2,570.40 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $4,466.84
| Professional | | $1,862.09 | $1,862.09 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $5,754.40 / $13,182.57
| Facility | | $3,467.37 | $5,754.40 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,467.37 / $6,606.93
| Professional | | $2,137.96 | $3,467.37 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,290.87
| Facility | | $2,187.76 | $2,187.76 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,187.76 / $2,187.76
| Professional | | $2,041.74 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $50,118.72 / $75,857.76
| Facility | | $4,677.35 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,311.31 / $3,311.31
| Professional | | $2,238.72 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,398.83 / $9,772.37
| Facility | | $1,348.96 | $2,398.83 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,238.72 / $5,754.40
| Professional | | $1,122.02 | $2,238.72 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,137.96 / $2,290.87
| Facility | | $2,041.74 | $2,137.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,187.76 / $2,187.76
| Professional | | $2,041.74 | $2,187.76 | $2,187.76 |