- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,388.44 / $3,715.35
| Facility | | $3,235.94 | $3,388.44 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,290.87 / $3,715.35
| Professional | | $1,862.09 | $2,290.87 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $4,897.79
| Facility | | $2,454.71 | $2,454.71 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $5,128.61 / $6,309.57
| Professional | | $2,454.71 | $5,128.61 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,677.35 / $5,623.41
| Professional | | $4,168.69 | $4,677.35 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $5,623.41 / $20,417.38
| Facility | | $2,951.21 | $5,623.41 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,951.21 / $7,244.36
| Professional | | $2,041.74 | $2,951.21 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $5,011.87 / $5,888.44
| Professional | | $4,786.30 | $5,011.87 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $7,244.36 / $7,244.36
| Professional | | $4,466.84 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $4,466.84 / $10,471.29
| Facility | | $1,949.84 | $4,466.84 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,344.23 / $4,168.69
| Professional | | $1,995.26 | $2,344.23 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,265.80 / $4,265.80
| Professional | | $3,388.44 | $4,265.80 | $4,265.80 |