- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $6,165.95 / $6,606.93
| Facility | | $5,754.40 | $6,165.95 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,073.80 / $6,606.93
| Professional | | $3,311.31 | $4,073.80 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $4,365.16 / $8,709.64
| Facility | | $4,365.16 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $9,120.11 / $11,481.54
| Professional | | $4,365.16 | $9,120.11 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $8,128.31 / $9,120.11
| Professional | | $6,760.83 | $8,128.31 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $8,511.38 / $33,884.42
| Facility | | $5,370.32 | $8,511.38 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $5,248.07 / $13,182.57
| Professional | | $3,715.35 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $8,912.51 / $10,715.19
| Professional | | $8,511.38 | $8,912.51 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $13,182.57 / $13,182.57
| Professional | | $8,128.31 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $5,248.07 / $5,888.44
| Facility | | $2,884.03 | $5,248.07 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $4,168.69 / $7,413.10
| Professional | | $3,630.78 | $4,168.69 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $7,585.78 / $7,585.78
| Professional | | $6,025.60 | $7,585.78 | $7,585.78 |