- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $7,943.28 / $15,135.61
| Facility | | $4,570.88 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $977.24 / $3,981.07
| Professional | | $676.08 | $977.24 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $11,748.98 / $22,908.68
| Facility | | $9,120.11 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,122.02 / $1,621.81
| Professional | | $676.08 | $1,122.02 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,659.59 / $2,137.96
| Professional | | $812.83 | $1,659.59 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,202.26 / $8,912.51
| Facility | | $676.08 | $1,202.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,380.38 / $5,370.32
| Professional | | $776.25 | $1,380.38 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,737.80 / $2,290.87
| Professional | | $1,412.54 | $1,737.80 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,584.89 / $2,290.87
| Professional | | $1,412.54 | $1,584.89 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $7,413.10 / $9,120.11
| Facility | | $6,309.57 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,318.26 / $1,862.09
| Professional | | $831.76 | $1,318.26 | $1,862.09 |