- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $8,511.38 / $16,218.10
| Facility | | $4,786.30 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,754.23 / $10,232.93
| Professional | | $1,659.59 | $2,754.23 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $15,488.17 / $30,199.52
| Facility | | $11,748.98 | $15,488.17 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,754.23 / $3,715.35
| Professional | | $1,621.81 | $2,754.23 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,125.38 / $14,125.38 / $14,125.38
| Facility | | $14,125.38 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $4,265.80 / $5,248.07
| Professional | | $2,137.96 | $4,265.80 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,019.95 / $15,488.17
| Facility | | $1,659.59 | $3,019.95 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,388.44 / $14,125.38
| Professional | | $2,041.74 | $3,388.44 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $4,365.16 / $6,025.60
| Professional | | $3,548.13 | $4,365.16 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,125.38 / $14,125.38 / $14,125.38
| Facility | | $14,125.38 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $4,073.80 / $6,025.60
| Professional | | $3,548.13 | $4,073.80 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $13,489.63 / $19,498.45
| Facility | | $8,317.64 | $13,489.63 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,311.31 / $4,897.79
| Professional | | $2,041.74 | $3,311.31 | $4,897.79 |