- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $7,943.28 / $14,454.40
| Facility | | $5,495.41 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,019.95 / $15,848.93
| Professional | | $2,570.40 | $3,019.95 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $10,964.78 / $21,379.62
| Facility | | $8,511.38 | $10,964.78 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $4,265.80 / $5,754.40
| Professional | | $2,511.89 | $4,265.80 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $6,456.54 / $8,709.64
| Professional | | $3,311.31 | $6,456.54 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,365.16 / $42,657.95
| Facility | | $2,570.40 | $4,365.16 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $5,754.40 / $21,379.62
| Professional | | $3,467.37 | $5,754.40 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $6,760.83 / $9,549.93
| Professional | | $6,606.93 | $6,760.83 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $6,165.95 / $6,165.95
| Professional | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $5,128.61 / $7,585.78
| Professional | | $10.96 | $5,128.61 | $7,585.78 |
- 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
- $3,715.35 / $5,248.07 / $7,079.46
| Professional | | $3,715.35 | $5,248.07 | $7,079.46 |