- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,238.72 / $3,162.28
| Facility | | $1,023.29 | $2,238.72 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,513.56 / $2,511.89
| Professional | | $1,148.15 | $1,513.56 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $5,754.40
| Facility | | $2,818.38 | $2,818.38 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $4,786.30
| Professional | | $1,621.81 | $1,621.81 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,344.23 / $2,344.23
| Facility | | $2,187.76 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,344.23 / $2,344.23
| Professional | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $53,703.18
| Facility | | $2,290.87 | $2,290.87 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $3,801.89
| Professional | | $1,659.59 | $1,659.59 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,677.35 / $10,964.78
| Facility | | $2,818.38 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,818.38 / $5,370.32
| Professional | | $1,778.28 | $2,818.38 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,137.96
| Facility | | $2,041.74 | $2,041.74 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,778.28 / $2,041.74
| Professional | | $1,698.24 | $1,778.28 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $50,118.72 / $75,857.76
| Facility | | $4,365.16 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,754.23 / $2,754.23
| Professional | | $1,862.09 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,995.26 / $7,943.28
| Facility | | $1,122.02 | $1,995.26 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,862.09 / $4,677.35
| Professional | | $933.25 | $1,862.09 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,698.24 / $2,137.96
| Facility | | $1,584.89 | $1,698.24 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,778.28 / $2,041.74
| Professional | | $1,698.24 | $1,778.28 | $2,041.74 |