- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $3,548.13 / $3,801.89
| Facility | | $3,311.31 | $3,548.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,344.23 / $3,801.89
| Professional | | $1,949.84 | $2,344.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $5,128.61
| Facility | | $2,951.21 | $2,951.21 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $5,248.07 / $6,606.93
| Professional | | $2,951.21 | $5,248.07 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $5,011.87 / $6,025.60
| Professional | | $4,265.80 | $5,011.87 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $5,754.40 / $21,379.62
| Facility | | $3,090.30 | $5,754.40 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,019.95 / $7,585.78
| Professional | | $2,137.96 | $3,019.95 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,128.61 / $6,165.95
| Professional | | $5,011.87 | $5,128.61 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $7,585.78 / $7,585.78
| Professional | | $4,677.35 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $4,570.88 / $10,715.19
| Facility | | $1,995.26 | $4,570.88 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,398.83 / $4,265.80
| Professional | | $2,089.30 | $2,398.83 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,466.84 / $4,466.84
| Professional | | $3,467.37 | $4,466.84 | $4,466.84 |