- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,162.28 / $9,120.11
| Facility | | $2,511.89 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,905.46 / $3,311.31
| Professional | | $1,318.26 | $1,905.46 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $5,888.44
| Facility | | $3,311.31 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $2,238.72 / $3,630.78
| Professional | | $141.25 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,365.16 / $5,370.32
| Professional | | $2,238.72 | $4,365.16 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,041.74 / $3,467.37
| Facility | | $1,949.84 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,454.71 / $3,019.95
| Professional | | $1,905.46 | $2,454.71 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $4,073.80
| Facility | | $2,041.74 | $2,041.74 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,344.23
| Professional | | $2,041.74 | $2,041.74 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,818.38 / $5,888.44
| Facility | | $1,949.84 | $2,818.38 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,290.87 / $2,951.21
| Professional | | $2,041.74 | $2,290.87 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $6,025.60 / $7,943.28
| Facility | | $3,548.13 | $6,025.60 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,737.80 / $2,454.71
| Professional | | $1,584.89 | $1,737.80 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,019.95 / $3,235.94
| Facility | | $2,454.71 | $3,019.95 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $2,454.71
| Professional | | $851.14 | $851.14 | $2,454.71 |