- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,981.07 / $4,265.80
| Facility | | $3,715.35 | $3,981.07 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,630.27 / $4,265.80
| Professional | | $2,137.96 | $2,630.27 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $5,623.41
| Facility | | $3,311.31 | $3,311.31 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $5,888.44 / $7,413.10
| Professional | | $3,311.31 | $5,888.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $5,128.61 / $6,025.60
| Professional | | $4,786.30 | $5,128.61 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $6,606.93 / $23,442.29
| Facility | | $3,467.37 | $6,606.93 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,388.44 / $8,511.38
| Professional | | $2,398.83 | $3,388.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $5,754.40 / $6,918.31
| Professional | | $5,495.41 | $5,754.40 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $8,511.38 / $8,511.38
| Professional | | $5,248.07 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $5,128.61 / $12,022.64
| Facility | | $2,238.72 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,691.53 / $4,786.30
| Professional | | $2,344.23 | $2,691.53 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,011.87 / $5,011.87
| Professional | | $3,890.45 | $5,011.87 | $5,011.87 |