- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,311.31 / $3,311.31
| Facility | | $3,235.94 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,235.94 / $5,248.07
| Professional | | $2,754.23 | $3,235.94 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $6,760.83
| Facility | | $6,309.57 | $6,309.57 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $7,943.28
| Professional | | $3,801.89 | $3,801.89 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $4,365.16
| Professional | | $3,311.31 | $3,311.31 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $4,897.79 / $4,897.79
| Facility | | $3,162.28 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $4,168.69
| Professional | | $3,548.13 | $3,548.13 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $6,309.57 / $8,912.51
| Professional | | $4,677.35 | $6,309.57 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,168.69 / $6,165.95
| Professional | | $3,235.94 | $4,168.69 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $4,570.88 / $8,317.64
| Facility | | $2,691.53 | $4,570.88 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,715.35 / $4,073.80
| Professional | | $3,388.44 | $3,715.35 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,128.61 / $10,000.00
| Facility | | $3,388.44 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,128.61 / $10,000.00
| Professional | | $3,388.44 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $4,677.35 / $6,309.57
| Facility | | $2,398.83 | $4,677.35 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,090.30 / $4,897.79
| Professional | | $2,884.03 | $3,090.30 | $4,897.79 |