- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $5,128.61
| Facility | | $4,168.69 | $4,168.69 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,019.95 / $4,570.88
| Professional | | $2,238.72 | $3,019.95 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $6,025.60
| Facility | | $3,981.07 | $3,981.07 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $7,079.46 / $8,912.51
| Professional | | $3,981.07 | $7,079.46 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $6,606.93 / $7,943.28
| Professional | | $5,128.61 | $6,606.93 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $7,079.46 / $27,542.29
| Facility | | $3,630.78 | $7,079.46 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,890.45 / $8,912.51
| Professional | | $2,570.40 | $3,890.45 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $6,165.95 / $7,943.28
| Professional | | $5,888.44 | $6,165.95 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $6,025.60
| Facility | | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $8,912.51 / $8,912.51
| Professional | | $6,025.60 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $5,495.41 / $13,803.84
| Facility | | $2,570.40 | $5,495.41 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,951.21 / $5,128.61
| Professional | | $2,630.27 | $2,951.21 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $5,248.07 / $5,248.07
| Professional | | $4,168.69 | $5,248.07 | $5,248.07 |