- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $10,715.19 / $23,988.33
| Professional | | $8,128.31 | $10,715.19 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $21,877.62 / $23,442.29
| Facility | | $3,467.37 | $21,877.62 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $15,488.17 / $16,218.10
| Professional | | $2,290.87 | $15,488.17 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,182.57 / $13,182.57 / $13,803.84
| Facility | | $13,182.57 | $13,182.57 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $11,220.18 / $13,182.57
| Professional | | $1,513.56 | $11,220.18 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $10,715.19 / $16,982.44
| Facility | | $2,089.30 | $10,715.19 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $10,715.19 / $23,988.33
| Professional | | $8,128.31 | $10,715.19 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,023.29 / $10,471.29
| Professional | | $758.58 | $1,023.29 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15,135.61 / $15,135.61 / $16,218.10
| Professional | | $15,135.61 | $15,135.61 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,964.78 / $14,791.08 / $14,791.08
| Professional | | $10,964.78 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,445.44 / $9,549.93
| Facility | | $724.44 | $1,445.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $6,165.95 / $9,772.37
| Professional | | $5,623.41 | $6,165.95 | $9,772.37 |