- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $5,754.40
| Facility | | $3,311.31 | $3,311.31 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,311.31 / $5,370.32
| Professional | | $2,630.27 | $3,311.31 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $7,244.36 / $14,791.08
| Facility | | $6,918.31 | $7,244.36 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,073.80 / $8,912.51
| Professional | | $3,388.44 | $4,073.80 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $5,370.32 / $7,585.78
| Facility | | $3,162.28 | $5,370.32 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $5,754.40 / $8,511.38
| Professional | | $4,168.69 | $5,754.40 | $8,511.38 |
- 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
- $2,754.23 / $2,754.23 / $3,801.89
| Professional | | $2,754.23 | $2,754.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $3,801.89
| Professional | | $2,754.23 | $2,754.23 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $4,897.79 / $7,079.46
| Professional | | $3,548.13 | $4,897.79 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $7,585.78 / $14,125.38
| Professional | | $6,456.54 | $7,585.78 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $5,495.41 / $8,317.64
| Facility | | $2,754.23 | $5,495.41 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,311.31 / $4,677.35
| Professional | | $2,238.72 | $3,311.31 | $4,677.35 |