- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,630.27 / $3,090.30
| Professional | | $1,949.84 | $2,630.27 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,174.90 / $1,479.11
| Facility | | $933.25 | $1,174.90 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $302.00 / $302.00
| Professional | | $229.09 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $724.44 / $724.44
| Professional | | $602.56 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,290.87
| Facility | | $2,238.72 | $2,238.72 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $2,691.53
| Facility | | $2,570.40 | $2,570.40 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $3,090.30
| Professional | | $2,187.76 | $2,187.76 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $3,311.31 / $3,311.31
| Facility | | $100.00 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $2,238.72 / $3,388.44
| Facility | | $346.74 | $2,238.72 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,090.30 / $3,090.30
| Professional | | $1,995.26 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $316.23 / $3,162.28
| Professional | | $93.33 | $316.23 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $2,238.72 / $3,090.30
| Facility | | $346.74 | $2,238.72 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $3,090.30
| Professional | | $2,187.76 | $2,187.76 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $912.01 / $2,089.30
| Facility | | $169.82 | $912.01 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,548.82 / $2,754.23
| Professional | | $1,071.52 | $1,548.82 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,089.30
| Professional | | $2,041.74 | $2,041.74 | $2,089.30 |