- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,041.74 / $3,019.95
| Professional | | $1,621.81 | $2,041.74 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $4,168.69
| Facility | | $3,890.45 | $3,890.45 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $4,466.84
| Professional | | $2,137.96 | $2,137.96 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,691.53
| Professional | | $2,041.74 | $2,041.74 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,137.96 / $2,137.96
| Facility | | $1,737.80 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $2,137.96
| Professional | | $1,584.89 | $1,584.89 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,890.45 / $5,495.41
| Professional | | $2,951.21 | $3,890.45 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,570.40 / $3,890.45
| Professional | | $1,819.70 | $2,570.40 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,630.27 / $4,570.88
| Facility | | $1,513.56 | $2,630.27 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,238.72 / $2,570.40
| Professional | | $2,089.30 | $2,238.72 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,235.94 / $7,585.78
| Facility | | $2,089.30 | $3,235.94 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,235.94 / $7,585.78
| Professional | | $2,089.30 | $3,235.94 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,570.40 / $4,677.35
| Facility | | $1,318.26 | $2,570.40 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,905.46 / $3,019.95
| Professional | | $1,737.80 | $1,905.46 | $3,019.95 |