- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,466.84 / $16,982.44
| Facility | | $3,235.94 | $4,466.84 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,019.95 / $4,897.79
| Professional | | $2,454.71 | $3,019.95 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $4,570.88 / $6,456.54
| Facility | | $4,570.88 | $4,570.88 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $6,606.93 / $8,317.64
| Professional | | $4,570.88 | $6,606.93 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $6,309.57 / $7,585.78
| Professional | | $5,370.32 | $6,309.57 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $6,309.57 / $26,915.35
| Facility | | $3,890.45 | $6,309.57 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,890.45 / $9,549.93
| Professional | | $2,691.53 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,606.93 / $7,762.47
| Professional | | $6,309.57 | $6,606.93 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $6,456.54 / $6,456.54
| Facility | | $6,456.54 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $9,549.93 / $9,549.93
| Professional | | $5,888.44 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,890.45 / $4,265.80
| Facility | | $2,137.96 | $3,890.45 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,019.95 / $5,495.41
| Professional | | $2,630.27 | $3,019.95 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $5,754.40 / $5,754.40
| Professional | | $4,466.84 | $5,754.40 | $5,754.40 |