- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $7,585.78 / $14,454.40
| Facility | | $4,265.80 | $7,585.78 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,949.84 / $7,943.28
| Professional | | $1,318.26 | $1,949.84 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $10,471.29 / $20,417.38
| Facility | | $7,943.28 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,238.72 / $3,162.28
| Professional | | $1,318.26 | $2,238.72 | $3,162.28 |
- 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
- $1,584.89 / $3,311.31 / $4,168.69
| Professional | | $1,584.89 | $3,311.31 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,398.83 / $10,471.29
| Facility | | $1,318.26 | $2,398.83 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,691.53 / $10,715.19
| Professional | | $1,318.26 | $2,691.53 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,311.31 / $4,570.88
| Professional | | $2,754.23 | $3,311.31 | $4,570.88 |
- 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
- $2,754.23 / $3,162.28 / $4,570.88
| Professional | | $2,754.23 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $7,585.78 / $10,964.78
| Facility | | $4,677.35 | $7,585.78 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,454.71 / $3,630.78
| Professional | | $1,318.26 | $2,454.71 | $3,630.78 |