- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $7,943.28 / $14,454.40
| Facility | | $4,897.79 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,388.44 / $14,791.08
| Professional | | $2,511.89 | $3,388.44 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $10,964.78 / $21,379.62
| Facility | | $8,317.64 | $10,964.78 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $4,073.80 / $5,495.41
| Professional | | $2,398.83 | $4,073.80 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20,892.96 / $20,892.96 / $20,892.96
| Facility | | $20,892.96 | $20,892.96 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $6,309.57 / $7,762.47
| Professional | | $3,019.95 | $6,309.57 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $4,365.16 / $15,488.17
| Facility | | $2,511.89 | $4,365.16 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $5,011.87 / $20,892.96
| Professional | | $2,884.03 | $5,011.87 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $6,309.57 / $8,511.38
| Professional | | $5,248.07 | $6,309.57 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20,892.96 / $20,892.96 / $20,892.96
| Facility | | $20,892.96 | $20,892.96 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $6,025.60 / $8,511.38
| Professional | | $5,248.07 | $6,025.60 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $13,803.84 / $26,302.68
| Facility | | $8,317.64 | $13,803.84 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,897.79 / $6,760.83
| Professional | | $3,235.94 | $4,897.79 | $6,760.83 |