- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,630.27
| Facility | | $2,398.83 | $2,398.83 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,398.83 / $4,570.88
| Professional | | $1,905.46 | $2,398.83 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $3,311.31
| Professional | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $5,623.41 / $5,623.41
| Facility | | $79.43 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $3,162.28
| Professional | | $2,290.87 | $2,290.87 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20,892.96 / $20,892.96 / $20,892.96
| Facility | | $20,892.96 | $20,892.96 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27,542.29 / $35,481.34 / $35,481.34
| Professional | | $27,542.29 | $35,481.34 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $4,168.69 / $6,918.31
| Facility | | $1,778.28 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,454.71 / $5,370.32
| Professional | | $2,041.74 | $2,454.71 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $3,890.45
| Professional | | $3,801.89 | $3,801.89 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $4,168.69 / $6,918.31
| Facility | | $1,862.09 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $3,162.28
| Professional | | $2,290.87 | $2,290.87 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,235.94 / $4,786.30
| Facility | | $1,862.09 | $3,235.94 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,511.89 / $3,162.28
| Professional | | $1,698.24 | $2,511.89 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $5,623.41 / $5,623.41
| Professional | | $2,511.89 | $5,623.41 | $5,623.41 |