- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,454.71 / $3,630.78
| Professional | | $1,778.28 | $2,454.71 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $1,862.09
| Professional | | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $9,120.11 / $11,220.18
| Professional | | $4,073.80 | $9,120.11 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,073.80 / $5,370.32
| Facility | | $3,235.94 | $4,073.80 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,265.80 / $5,754.40
| Professional | | $3,890.45 | $4,265.80 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $5,248.07 / $5,370.32
| Facility | | $4,265.80 | $5,248.07 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $5,370.32 / $5,370.32
| Professional | | $4,570.88 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,265.80 / $5,754.40
| Facility | | $2,344.23 | $4,265.80 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $4,570.88 / $5,623.41
| Professional | | $79.43 | $4,570.88 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $8,511.38 / $20,892.96
| Facility | | $4,466.84 | $8,511.38 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $6,025.60 / $6,025.60
| Professional | | $5,370.32 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,162.28 / $6,606.93
| Facility | | $2,691.53 | $3,162.28 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,041.74 / $3,890.45
| Professional | | $1,621.81 | $2,041.74 | $3,890.45 |