- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,137.96 / $3,548.13
| Professional | | $1,659.59 | $2,137.96 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $7,079.46
| Facility | | $4,265.80 | $4,265.80 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $4,786.30
| Professional | | $3,981.07 | $3,981.07 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $10,000.00 / $20,892.96
| Facility | | $2,951.21 | $10,000.00 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $6,165.95 / $8,128.31
| Professional | | $2,187.76 | $6,165.95 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,548.13 / $5,370.32
| Facility | | $2,089.30 | $3,548.13 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $4,073.80 / $5,128.61
| Professional | | $2,398.83 | $4,073.80 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $4,168.69 / $19,054.61
| Facility | | $2,137.96 | $4,168.69 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,630.27 / $4,786.30
| Professional | | $1,905.46 | $2,630.27 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $2,290.87
| Professional | | $54.95 | $70.79 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $6,760.83 / $6,760.83
| Facility | | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $4,897.79 / $8,511.38
| Professional | | $3,019.95 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $6,456.54 / $11,748.98
| Professional | | $4,265.80 | $6,456.54 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $8,511.38 / $19,498.45
| Facility | | $2,951.21 | $8,511.38 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $4,365.16 / $23,988.33
| Professional | | $2,187.76 | $4,365.16 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,754.23 / $4,265.80
| Facility | | $2,187.76 | $2,754.23 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,137.96 / $3,630.78
| Professional | | $1,659.59 | $2,137.96 | $3,630.78 |