- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,778.28 / $2,691.53
| Professional | | $1,318.26 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Professional | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $6,606.93 / $7,943.28
| Professional | | $2,398.83 | $6,606.93 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $2,238.72 / $3,090.30
| Facility | | $933.25 | $2,238.72 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,511.89 / $3,388.44
| Professional | | $2,290.87 | $2,511.89 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,019.95 / $3,090.30
| Facility | | $2,454.71 | $3,019.95 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,951.21 / $3,090.30
| Professional | | $2,818.38 | $2,951.21 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,630.27 / $3,981.07
| Facility | | $1,659.59 | $2,630.27 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $2,691.53 / $3,311.31
| Professional | | $79.43 | $2,691.53 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,897.79 / $12,302.69
| Facility | | $2,570.40 | $4,897.79 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,467.37 / $3,467.37
| Professional | | $3,162.28 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,949.84 / $4,786.30
| Facility | | $776.25 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,479.11 / $2,818.38
| Professional | | $1,202.26 | $1,479.11 | $2,818.38 |