- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $12,589.25 / $20,892.96
| Professional | | $6,606.93 | $12,589.25 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $15,848.93 / $20,892.96
| Professional | | $10,471.29 | $15,848.93 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $23,442.29
| Facility | | $1,819.70 | $1,819.70 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $23,442.29
| Professional | | $1,819.70 | $1,819.70 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $11,220.18 / $13,182.57
| Professional | | $1,621.81 | $11,220.18 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $12,022.64 / $12,022.64
| Professional | | $9,772.37 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,022.64 / $12,022.64 / $12,022.64
| Facility | | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $10,471.29 / $12,022.64
| Professional | | $10,471.29 | $10,471.29 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,187.76 / $9,120.11
| Facility | | $691.83 | $2,187.76 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $7,244.36 / $11,748.98
| Professional | | $70.79 | $7,244.36 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,232.93 / $10,471.29 / $12,022.64
| Facility | | $10,232.93 | $10,471.29 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $10,471.29 / $12,022.64
| Professional | | $10,471.29 | $10,471.29 | $12,022.64 |