- 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
- $1,584.89 / $2,570.40 / $9,549.93
| Professional | | $1,584.89 | $2,570.40 | $9,549.93 |
- 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
- $1,548.82 / $2,630.27 / $3,548.13
| Professional | | $1,548.82 | $2,630.27 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20,417.38 / $20,417.38 / $20,417.38
| Facility | | $20,417.38 | $20,417.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,981.07 / $5,011.87
| Professional | | $2,041.74 | $3,981.07 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,818.38 / $15,488.17
| Facility | | $1,584.89 | $2,818.38 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $3,311.31 / $19,054.61
| Professional | | $1,905.46 | $3,311.31 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,073.80 / $5,623.41
| Professional | | $3,388.44 | $4,073.80 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20,417.38 / $20,417.38 / $20,417.38
| Facility | | $20,417.38 | $20,417.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,801.89 / $5,623.41
| Professional | | $3,388.44 | $3,801.89 | $5,623.41 |
- 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
- $1,995.26 / $3,162.28 / $4,677.35
| Professional | | $1,995.26 | $3,162.28 | $4,677.35 |