- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,630.78 / $3,630.78
| Professional | | $2,570.40 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $8,511.38 / $8,511.38
| Facility | | $4,677.35 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,677.35 / $5,888.44
| Professional | | $2,951.21 | $4,677.35 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,162.28 / $20,417.38
| Facility | | $2,691.53 | $3,162.28 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $6,165.95 / $9,120.11
| Professional | | $2,290.87 | $6,165.95 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $3,019.95 / $4,786.30
| Facility | | $363.08 | $3,019.95 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Professional | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $3,630.78 / $5,370.32
| Facility | | $288.40 | $3,630.78 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,454.71 / $4,466.84
| Professional | | $1,698.24 | $2,454.71 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $251.19 / $2,454.71
| Professional | | $11.22 | $251.19 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,047.13 / $1,230.27
| Professional | | $524.81 | $1,047.13 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $5,370.32 / $5,370.32
| Facility | | $64.57 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $2,691.53 / $3,235.94
| Professional | | $380.19 | $2,691.53 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $707.95 / $3,162.28
| Facility | | $263.03 | $707.95 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,398.83 / $4,466.84
| Professional | | $1,479.11 | $2,398.83 | $4,466.84 |