- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $30,902.95
| Facility | | $4,265.80 | $4,265.80 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,265.80 / $26,915.35
| Professional | | $3,467.37 | $4,265.80 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,073.80 / $17,378.01
| Facility | | $3,235.94 | $4,073.80 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $11,220.18
| Professional | | $4,265.80 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $10,471.29 / $16,595.87
| Facility | | $4,265.80 | $10,471.29 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $12,882.50 / $26,302.68
| Professional | | $6,760.83 | $12,882.50 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,677.35 / $4,677.35
| Facility | | $3,311.31 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $4,677.35
| Professional | | $3,467.37 | $3,467.37 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,235.94 / $8,709.64
| Professional | | $2,570.40 | $3,235.94 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $6,456.54 / $11,220.18
| Professional | | $4,265.80 | $6,456.54 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36,307.81 / $36,307.81 / $36,307.81
| Facility | | $36,307.81 | $36,307.81 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47,863.01 / $52,480.75 / $52,480.75
| Professional | | $47,863.01 | $52,480.75 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $9,332.54 / $9,332.54
| Professional | | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $6,918.31 / $9,549.93
| Facility | | $2,570.40 | $6,918.31 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $7,079.46
| Professional | | $3,467.37 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13,182.57 / $13,182.57 / $13,182.57
| Professional | | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,311.31 / $6,456.54
| Professional | | $2,570.40 | $3,311.31 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $4,677.35 / $9,549.93
| Facility | | $575.44 | $4,677.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,265.80 / $7,943.28
| Professional | | $3,311.31 | $4,265.80 | $7,943.28 |