- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,162.28 / $3,388.44
| Facility | | $2,951.21 | $3,162.28 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,137.96 / $3,467.37
| Professional | | $1,737.80 | $2,137.96 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $4,570.88
| Facility | | $2,290.87 | $2,290.87 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $4,677.35 / $5,888.44
| Professional | | $2,290.87 | $4,677.35 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,073.80 / $4,786.30
| Professional | | $3,467.37 | $4,073.80 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $5,248.07 / $19,054.61
| Facility | | $2,754.23 | $5,248.07 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,754.23 / $6,760.83
| Professional | | $1,905.46 | $2,754.23 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,570.88 / $5,495.41
| Professional | | $4,466.84 | $4,570.88 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $6,760.83 / $6,760.83
| Professional | | $4,168.69 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $4,073.80 / $9,772.37
| Facility | | $1,819.70 | $4,073.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,187.76 / $3,801.89
| Professional | | $1,862.09 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,981.07 / $3,981.07
| Professional | | $3,162.28 | $3,981.07 | $3,981.07 |