- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $9,549.93 / $15,488.17
| Facility | | $6,025.60 | $9,549.93 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,621.81 / $4,897.79
| Professional | | $977.24 | $1,621.81 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $2,187.76
| Professional | | $302.00 | $302.00 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $9,549.93 / $18,620.87
| Facility | | $7,413.10 | $9,549.93 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,621.81 / $2,344.23
| Professional | | $977.24 | $1,621.81 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,398.83 / $3,019.95
| Professional | | $1,148.15 | $2,398.83 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,778.28 / $10,471.29
| Facility | | $977.24 | $1,778.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,041.74 / $7,943.28
| Professional | | $1,202.26 | $2,041.74 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,398.83 / $3,311.31
| Professional | | $2,041.74 | $2,398.83 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,344.23 / $3,311.31
| Professional | | $2,041.74 | $2,344.23 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $7,585.78 / $10,964.78
| Facility | | $6,309.57 | $7,585.78 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,905.46 / $2,691.53
| Professional | | $1,230.27 | $1,905.46 | $2,691.53 |