- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,884.03 / $4,786.30
| Professional | | $2,511.89 | $2,884.03 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $5,888.44 / $9,772.37
| Facility | | $5,888.44 | $5,888.44 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $5,495.41 / $6,606.93
| Professional | | $5,495.41 | $5,495.41 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $18,197.01 / $28,840.32
| Facility | | $4,570.88 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $8,317.64 / $10,964.78
| Professional | | $3,890.45 | $8,317.64 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,786.30 / $7,244.36
| Facility | | $2,818.38 | $4,786.30 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $5,623.41 / $6,918.31
| Professional | | $3,311.31 | $5,623.41 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $5,754.40 / $26,915.35
| Facility | | $2,884.03 | $5,754.40 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,630.78 / $6,456.54
| Professional | | $2,630.27 | $3,630.78 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $4,570.88
| Professional | | $54.95 | $70.79 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $6,606.93 / $11,481.54
| Professional | | $4,168.69 | $6,606.93 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $8,709.64 / $16,218.10
| Professional | | $5,888.44 | $8,709.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $11,748.98 / $26,915.35
| Facility | | $4,570.88 | $11,748.98 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $6,309.57 / $28,840.32
| Professional | | $3,890.45 | $6,309.57 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,890.45 / $4,168.69
| Facility | | $3,019.95 | $3,890.45 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,884.03 / $4,786.30
| Professional | | $2,238.72 | $2,884.03 | $4,786.30 |