- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,019.95 / $6,165.95
| Professional | | $2,818.38 | $3,019.95 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $7,762.47 / $10,715.19
| Facility | | $1,071.52 | $7,762.47 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,548.13 / $7,413.10
| Professional | | $707.95 | $3,548.13 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $2,818.38
| Facility | | $2,691.53 | $2,691.53 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $2,290.87 / $3,235.94
| Professional | | $380.19 | $2,290.87 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $3,467.37 / $6,165.95
| Facility | | $512.86 | $3,467.37 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,019.95 / $6,165.95
| Professional | | $2,818.38 | $3,019.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $3,162.28
| Professional | | $234.42 | $316.23 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,388.44 / $3,548.13
| Professional | | $3,388.44 | $3,388.44 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $4,570.88
| Professional | | $3,235.94 | $3,235.94 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $3,388.44
| Facility | | $263.03 | $363.08 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,089.30 / $3,388.44
| Professional | | $1,778.28 | $2,089.30 | $3,388.44 |