- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $7,943.28 / $14,454.40
| Facility | | $5,623.41 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,235.94 / $6,918.31
| Professional | | $2,754.23 | $3,235.94 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $14,791.08 / $28,840.32
| Facility | | $11,220.18 | $14,791.08 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,466.84 / $6,025.60
| Professional | | $2,630.27 | $4,466.84 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $5,623.41 / $9,772.37
| Professional | | $1,445.44 | $5,623.41 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $4,365.16 / $6,918.31
| Facility | | $2,754.23 | $4,365.16 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,754.40 / $22,387.21
| Professional | | $3,388.44 | $5,754.40 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $6,760.83 / $9,772.37
| Professional | | $5,754.40 | $6,760.83 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $5,754.40 / $9,772.37
| Professional | | $4,786.30 | $5,754.40 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $4,897.79 / $7,762.47
| Professional | | $15.14 | $4,897.79 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,466.84 / $8,128.31
| Facility | | $3,235.94 | $4,466.84 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,570.88 / $7,079.46
| Professional | | $3,388.44 | $4,570.88 | $7,079.46 |