- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $6,918.31
| Facility | | $4,168.69 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $4,168.69 / $6,918.31
| Professional | | $3,548.13 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $9,332.54 / $18,620.87
| Facility | | $8,709.64 | $9,332.54 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $6,025.60 / $11,481.54
| Professional | | $4,570.88 | $6,025.60 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $7,079.46 / $10,000.00
| Facility | | $4,168.69 | $7,079.46 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $7,585.78 / $11,220.18
| Professional | | $5,370.32 | $7,585.78 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $5,011.87
| Facility | | $4,786.30 | $4,786.30 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $4,786.30
| Professional | | $4,073.80 | $4,073.80 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $4,786.30
| Professional | | $4,073.80 | $4,073.80 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $6,309.57 / $9,120.11
| Professional | | $4,466.84 | $6,309.57 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $10,471.29 / $10,471.29
| Facility | | $10,471.29 | $10,471.29 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $9,772.37 / $18,197.01
| Professional | | $8,317.64 | $9,772.37 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $7,079.46 / $10,232.93
| Facility | | $3,467.37 | $7,079.46 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,265.80 / $6,165.95
| Professional | | $2,884.03 | $4,265.80 | $6,165.95 |