- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,548.13 / $5,128.61
| Facility | | $2,511.89 | $3,548.13 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,570.40 / $3,801.89
| Professional | | $2,511.89 | $2,570.40 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,630.27 / $3,235.94
| Professional | | $2,570.40 | $2,630.27 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,467.37 / $5,623.41
| Professional | | $2,238.72 | $3,467.37 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,630.27 / $4,168.69
| Facility | | $2,041.74 | $2,630.27 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,818.38 / $12,022.64
| Professional | | $2,570.40 | $2,818.38 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,235.94 / $3,890.45
| Professional | | $2,398.83 | $3,235.94 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $4,168.69 / $5,248.07
| Professional | | $1,698.24 | $4,168.69 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $4,466.84 / $5,623.41
| Professional | | $2,754.23 | $4,466.84 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $3,548.13
| Facility | | $2,630.27 | $2,630.27 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,691.53 / $3,162.28
| Professional | | $2,511.89 | $2,691.53 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $2,884.03
| Facility | | $2,754.23 | $2,754.23 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,754.23 / $2,884.03
| Professional | | $2,187.76 | $2,754.23 | $2,884.03 |