- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,548.13 / $5,011.87
| Professional | | $2,290.87 | $3,548.13 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $5,623.41 / $7,413.10
| Facility | | $741.31 | $5,623.41 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $3,388.44 / $5,128.61
| Professional | | $478.63 | $3,388.44 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,344.23
| Facility | | $2,238.72 | $2,238.72 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,905.46 / $2,238.72
| Professional | | $346.74 | $1,905.46 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,995.26 / $3,630.78
| Facility | | $436.52 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,548.13 / $5,011.87
| Professional | | $2,290.87 | $3,548.13 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $3,235.94
| Professional | | $323.59 | $323.59 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $3,388.44
| Professional | | $3,235.94 | $3,235.94 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,090.30 / $3,090.30
| Professional | | $2,290.87 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $954.99 / $2,290.87
| Facility | | $151.36 | $954.99 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,380.38 / $2,290.87
| Professional | | $1,174.90 | $1,380.38 | $2,290.87 |