- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,981.07 / $4,570.88
| Facility | | $3,715.35 | $3,981.07 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $4,466.84 / $6,456.54
| Professional | | $3,715.35 | $4,466.84 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $6,606.93 / $7,943.28
| Professional | | $6,606.93 | $6,606.93 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $8,317.64 / $8,912.51
| Professional | | $6,606.93 | $8,317.64 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $13,803.84
| Facility | | $6,025.60 | $6,025.60 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $4,365.16 / $6,025.60
| Professional | | $4,365.16 | $4,365.16 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $4,365.16
| Facility | | $3,019.95 | $3,019.95 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,370.32 / $8,912.51
| Professional | | $3,890.45 | $5,370.32 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,570.88 / $5,754.40
| Professional | | $2,951.21 | $4,570.88 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $5,888.44 / $10,471.29
| Facility | | $3,467.37 | $5,888.44 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $4,365.16 / $5,888.44
| Professional | | $3,715.35 | $4,365.16 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $4,570.88 / $8,912.51
| Professional | | $4,570.88 | $4,570.88 | $8,912.51 |