- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,995.26 / $1,995.26
| Facility | | $1,949.84 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,949.84 / $2,951.21
| Professional | | $1,621.81 | $1,949.84 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $3,981.07
| Facility | | $3,801.89 | $3,801.89 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,089.30 / $4,365.16
| Professional | | $2,089.30 | $2,089.30 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,630.27
| Professional | | $2,238.72 | $2,238.72 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,454.71 / $2,454.71
| Facility | | $1,621.81 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $2,454.71
| Professional | | $1,778.28 | $1,778.28 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,801.89 / $5,248.07
| Professional | | $2,818.38 | $3,801.89 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,454.71 / $3,715.35
| Professional | | $1,905.46 | $2,454.71 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,570.40 / $4,365.16
| Facility | | $1,584.89 | $2,570.40 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,290.87 / $2,454.71
| Professional | | $2,041.74 | $2,290.87 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,090.30 / $7,413.10
| Facility | | $2,041.74 | $3,090.30 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,090.30 / $7,413.10
| Professional | | $2,041.74 | $3,090.30 | $7,413.10 |
- 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 / $1,862.09 / $2,951.21
| Professional | | $1,737.80 | $1,862.09 | $2,951.21 |