- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,365.16 / $4,365.16
| Facility | | $4,168.69 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,818.38 / $5,011.87
| Professional | | $2,238.72 | $2,818.38 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,311.31 / $6,309.57
| Facility | | $3,311.31 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $6,025.60 / $7,585.78
| Professional | | $3,311.31 | $6,025.60 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,623.41 / $6,165.95
| Professional | | $5,011.87 | $5,623.41 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,244.36 / $25,118.86
| Facility | | $4,073.80 | $7,244.36 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,548.13 / $9,549.93
| Professional | | $2,691.53 | $3,548.13 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $6,760.83 / $18,197.01
| Professional | | $6,165.95 | $6,760.83 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $6,309.57
| Facility | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $9,549.93 / $18,197.01
| Professional | | $9,549.93 | $9,549.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $5,754.40 / $12,022.64
| Facility | | $2,238.72 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,951.21 / $5,370.32
| Professional | | $2,398.83 | $2,951.21 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $5,495.41 / $5,495.41
| Professional | | $4,365.16 | $5,495.41 | $5,495.41 |