- 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
- $912.01 / $1,412.54 / $5,495.41
| Professional | | $912.01 | $1,412.54 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,882.50 / $16,982.44 / $33,113.11
| Facility | | $12,882.50 | $16,982.44 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,548.82 / $2,187.76
| Professional | | $912.01 | $1,548.82 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,877.62 / $21,877.62 / $21,877.62
| Facility | | $21,877.62 | $21,877.62 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $2,290.87 / $2,884.03
| Professional | | $1,096.48 | $2,290.87 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,659.59 / $26,915.35
| Facility | | $912.01 | $1,659.59 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,862.09 / $7,413.10
| Professional | | $1,047.13 | $1,862.09 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,290.87 / $3,090.30
| Professional | | $1,905.46 | $2,290.87 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,877.62 / $21,877.62 / $21,877.62
| Facility | | $21,877.62 | $21,877.62 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,187.76 / $3,090.30
| Professional | | $1,905.46 | $2,187.76 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $13,803.84 / $26,302.68
| Facility | | $8,317.64 | $13,803.84 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,778.28 / $2,570.40
| Professional | | $1,122.02 | $1,778.28 | $2,570.40 |