- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,454.71 / $4,677.35
| Facility | | $2,398.83 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,454.71 / $4,677.35
| Professional | | $2,089.30 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,467.37 / $4,897.79
| Professional | | $2,691.53 | $3,467.37 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,311.31 / $4,570.88
| Professional | | $2,691.53 | $3,311.31 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,951.21 / $5,370.32
| Professional | | $2,187.76 | $2,951.21 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,818.38 / $7,585.78
| Professional | | $2,344.23 | $2,818.38 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,467.37 / $6,309.57
| Professional | | $2,754.23 | $3,467.37 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,162.28 / $4,466.84
| Facility | | $2,344.23 | $3,162.28 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,019.95 / $10,000.00
| Facility | | $2,041.74 | $3,019.95 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,019.95 / $10,000.00
| Professional | | $2,041.74 | $3,019.95 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,890.45 / $7,079.46
| Facility | | $1,737.80 | $3,890.45 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,344.23 / $4,265.80
| Professional | | $2,137.96 | $2,344.23 | $4,265.80 |