- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,890.45 / $6,606.93
| Professional | | $3,235.94 | $3,890.45 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $7,762.47 / $12,882.50
| Facility | | $7,762.47 | $7,762.47 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $7,244.36 / $8,709.64
| Professional | | $7,079.46 | $7,244.36 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $17,782.79 / $38,018.94
| Facility | | $4,897.79 | $17,782.79 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $10,964.78 / $14,791.08
| Professional | | $3,630.78 | $10,964.78 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $6,309.57 / $9,549.93
| Facility | | $3,890.45 | $6,309.57 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $7,244.36 / $9,332.54
| Professional | | $4,365.16 | $7,244.36 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $7,585.78 / $37,153.52
| Facility | | $3,890.45 | $7,585.78 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $5,128.61 / $8,709.64
| Professional | | $3,548.13 | $5,128.61 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $4,466.84
| Professional | | $54.95 | $70.79 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $8,709.64 / $15,135.61
| Professional | | $5,495.41 | $8,709.64 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $11,748.98 / $22,387.21
| Professional | | $7,762.47 | $11,748.98 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $15,488.17 / $37,153.52
| Facility | | $4,897.79 | $15,488.17 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $7,244.36 / $46,773.51
| Professional | | $3,630.78 | $7,244.36 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,370.32 / $7,762.47
| Facility | | $3,630.78 | $5,370.32 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,801.89 / $6,309.57
| Professional | | $2,951.21 | $3,801.89 | $6,309.57 |