- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $7,943.28 / $8,709.64
| Facility | | $7,585.78 | $7,943.28 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $5,248.07 / $8,511.38
| Professional | | $4,265.80 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $11,481.54
| Facility | | $5,623.41 | $5,623.41 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $12,022.64 / $15,135.61
| Professional | | $5,623.41 | $12,022.64 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $10,232.93 / $10,715.19
| Professional | | $8,709.64 | $10,232.93 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $11,481.54 / $44,668.36
| Facility | | $7,079.46 | $11,481.54 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $6,918.31 / $16,982.44
| Professional | | $4,786.30 | $6,918.31 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $12,882.50 / $26,915.35
| Professional | | $11,220.18 | $12,882.50 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16,982.44 / $16,982.44 / $16,982.44
| Professional | | $16,982.44 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $7,079.46 / $7,585.78
| Facility | | $3,715.35 | $7,079.46 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $5,370.32 / $10,232.93
| Professional | | $4,677.35 | $5,370.32 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $9,120.11 / $9,120.11
| Professional | | $7,244.36 | $9,120.11 | $9,120.11 |