- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $9,332.54 / $11,481.54
| Facility | | $9,332.54 | $9,332.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $6,456.54 / $10,471.29
| Professional | | $5,128.61 | $6,456.54 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $8,128.31 / $13,489.63
| Facility | | $8,128.31 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $14,454.40 / $18,197.01
| Professional | | $8,128.31 | $14,454.40 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $12,589.25 / $15,135.61
| Professional | | $11,481.54 | $12,589.25 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $15,848.93 / $61,659.50
| Facility | | $8,128.31 | $15,848.93 | $61,659.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $8,709.64 / $19,952.62
| Professional | | $5,754.40 | $8,709.64 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13,182.57 / $13,803.84 / $18,197.01
| Professional | | $13,182.57 | $13,803.84 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,489.63 / $13,489.63 / $13,489.63
| Facility | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13,803.84 / $19,952.62 / $19,952.62
| Professional | | $13,803.84 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $12,302.69 / $31,622.78
| Facility | | $5,011.87 | $12,302.69 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $6,456.54 / $11,481.54
| Professional | | $5,888.44 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $11,748.98 / $11,748.98
| Professional | | $9,332.54 | $11,748.98 | $11,748.98 |