- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,818.38
| Facility | | $2,398.83 | $2,398.83 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,089.30 / $3,388.44
| Professional | | $1,548.82 | $2,089.30 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,344.23 / $4,265.80
| Facility | | $2,344.23 | $2,344.23 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,466.84 / $5,623.41
| Professional | | $2,344.23 | $4,466.84 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,890.45 / $4,265.80
| Professional | | $3,311.31 | $3,890.45 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,570.88 / $17,782.79
| Facility | | $2,630.27 | $4,570.88 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,344.23 / $6,456.54
| Professional | | $1,737.80 | $2,344.23 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,365.16 / $5,248.07
| Professional | | $4,168.69 | $4,365.16 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $6,456.54 / $6,456.54
| Professional | | $3,981.07 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $3,890.45 / $9,120.11
| Facility | | $1,318.26 | $3,890.45 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,905.46 / $3,630.78
| Professional | | $1,698.24 | $1,905.46 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,801.89 / $3,801.89
| Professional | | $2,951.21 | $3,801.89 | $3,801.89 |