- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $5,248.07 / $7,762.47
| Facility | | $2,818.38 | $5,248.07 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $3,715.35
| Professional | | $2,818.38 | $2,818.38 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $5,248.07 / $14,454.40
| Facility | | $3,019.95 | $5,248.07 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,235.94 / $4,897.79
| Professional | | $2,818.38 | $3,235.94 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $3,630.78
| Professional | | $2,691.53 | $2,691.53 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $5,623.41 / $9,332.54
| Facility | | $2,818.38 | $5,623.41 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $3,548.13
| Professional | | $2,818.38 | $2,818.38 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,818.38 / $3,981.07
| Facility | | $2,630.27 | $2,818.38 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $3,981.07
| Professional | | $2,818.38 | $2,818.38 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,090.30 / $3,981.07
| Professional | | $2,691.53 | $3,090.30 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,162.28 / $5,370.32
| Professional | | $2,691.53 | $3,162.28 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $5,754.40
| Facility | | $2,818.38 | $2,818.38 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,818.38 / $3,162.28
| Professional | | $2,511.89 | $2,818.38 | $3,162.28 |