- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $7,079.46 / $8,511.38
| Facility | | $7,079.46 | $7,079.46 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $5,248.07 / $8,128.31
| Professional | | $3,981.07 | $5,248.07 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $6,606.93 / $10,232.93
| Facility | | $6,606.93 | $6,606.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $11,748.98 / $14,791.08
| Professional | | $6,606.93 | $11,748.98 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $10,232.93 / $12,022.64
| Professional | | $8,709.64 | $10,232.93 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $12,022.64 / $46,773.51
| Facility | | $6,309.57 | $12,022.64 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $6,606.93 / $15,135.61
| Professional | | $4,365.16 | $6,606.93 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,000.00 / $10,471.29 / $13,803.84
| Professional | | $10,000.00 | $10,471.29 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $15,135.61 / $15,135.61
| Professional | | $10,471.29 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $9,332.54 / $23,988.33
| Facility | | $3,981.07 | $9,332.54 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $5,011.87 / $8,709.64
| Professional | | $4,570.88 | $5,011.87 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $8,912.51 / $8,912.51
| Professional | | $7,079.46 | $8,912.51 | $8,912.51 |