- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $6,309.57 / $7,943.28
| Professional | | $4,570.88 | $6,309.57 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $8,912.51 / $10,715.19
| Facility | | $8,912.51 | $8,912.51 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $8,317.64 / $9,120.11
| Professional | | $8,317.64 | $8,317.64 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $7,244.36 / $7,244.36
| Facility | | $4,786.30 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $5,248.07 / $7,762.47
| Professional | | $5,248.07 | $5,248.07 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $4,677.35 / $6,760.83
| Professional | | $4,365.16 | $4,677.35 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $8,511.38 / $15,135.61
| Facility | | $4,466.84 | $8,511.38 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $0.60
| Professional | | $0.60 | $0.60 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $6,918.31 / $8,709.64
| Facility | | $4,365.16 | $6,918.31 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $5,370.32 / $7,585.78
| Professional | | $4,168.69 | $5,370.32 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48,977.88 / $48,977.88 / $48,977.88
| Facility | | $48,977.88 | $48,977.88 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53,703.18 / $53,703.18 / $69,183.10
| Professional | | $53,703.18 | $53,703.18 | $69,183.10 |