- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,467.37 / $3,715.35
| Facility | | $3,311.31 | $3,467.37 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,344.23 / $3,801.89
| Professional | | $1,905.46 | $2,344.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $5,011.87
| Facility | | $2,511.89 | $2,511.89 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $5,248.07 / $6,456.54
| Professional | | $2,511.89 | $5,248.07 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,786.30 / $5,754.40
| Professional | | $4,265.80 | $4,786.30 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $5,754.40 / $20,892.96
| Facility | | $3,019.95 | $5,754.40 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,019.95 / $7,413.10
| Professional | | $2,089.30 | $3,019.95 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $5,128.61 / $6,025.60
| Professional | | $4,897.79 | $5,128.61 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $7,413.10 / $7,413.10
| Professional | | $4,570.88 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $4,570.88 / $10,715.19
| Facility | | $1,995.26 | $4,570.88 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,398.83 / $4,265.80
| Professional | | $2,041.74 | $2,398.83 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,365.16 / $4,365.16
| Professional | | $3,467.37 | $4,365.16 | $4,365.16 |