- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,162.28 / $5,623.41
| Facility | | $2,818.38 | $3,162.28 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $4,168.69
| Professional | | $2,818.38 | $2,818.38 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,884.03 / $3,548.13
| Professional | | $2,818.38 | $2,884.03 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $5,370.32 / $8,511.38
| Professional | | $2,290.87 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,951.21 / $4,570.88
| Facility | | $2,691.53 | $2,951.21 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,019.95 / $11,748.98
| Professional | | $2,691.53 | $3,019.95 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,467.37 / $4,073.80
| Professional | | $3,162.28 | $3,467.37 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,467.37 / $6,165.95
| Professional | | $3,311.31 | $3,467.37 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $5,011.87 / $6,025.60
| Professional | | $3,019.95 | $5,011.87 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $3,019.95
| Facility | | $2,818.38 | $2,818.38 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,818.38 / $3,235.94
| Professional | | $2,630.27 | $2,818.38 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,090.30 / $3,090.30
| Facility | | $2,951.21 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,951.21 / $3,090.30
| Professional | | $2,454.71 | $2,951.21 | $3,090.30 |