- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,890.45 / $5,128.61
| Professional | | $3,162.28 | $3,890.45 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $7,585.78 / $7,943.28
| Facility | | $7,585.78 | $7,585.78 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $8,317.64
| Professional | | $3,981.07 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $5,128.61
| Professional | | $4,073.80 | $4,073.80 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,466.84 / $4,466.84
| Facility | | $2,884.03 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $3,235.94
| Professional | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $7,585.78 / $10,471.29
| Professional | | $5,623.41 | $7,585.78 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $5,011.87 / $5,128.61
| Professional | | $4,365.16 | $5,011.87 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,897.79 / $8,709.64
| Facility | | $2,818.38 | $4,897.79 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,570.88 / $4,897.79
| Professional | | $4,073.80 | $4,570.88 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $6,165.95 / $10,715.19
| Facility | | $4,073.80 | $6,165.95 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $6,165.95 / $10,715.19
| Professional | | $4,073.80 | $6,165.95 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $4,897.79 / $8,912.51
| Facility | | $2,511.89 | $4,897.79 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,630.78 / $5,754.40
| Professional | | $3,311.31 | $3,630.78 | $5,754.40 |