- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $7,943.28 / $14,454.40
| Facility | | $6,025.60 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,137.96 / $10,715.19
| Professional | | $1,819.70 | $2,137.96 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,232.93 / $13,182.57 / $25,703.96
| Facility | | $10,232.93 | $13,182.57 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,951.21 / $3,981.07
| Professional | | $1,737.80 | $2,951.21 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,466.84 / $5,888.44
| Professional | | $2,041.74 | $4,466.84 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,265.80 / $9,772.37
| Facility | | $2,344.23 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,981.07 / $14,454.40
| Professional | | $2,511.89 | $3,981.07 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,466.84 / $6,165.95
| Professional | | $4,265.80 | $4,466.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $3,090.30 / $5,011.87
| Professional | | $10.96 | $3,090.30 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $7,413.10 / $9,120.11
| Facility | | $6,309.57 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,630.78 / $4,897.79
| Professional | | $2,511.89 | $3,630.78 | $4,897.79 |