- 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
- $1,318.26 / $1,778.28 / $7,943.28
| Professional | | $1,318.26 | $1,778.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $5,623.41 / $10,964.78
| Facility | | $4,265.80 | $5,623.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,089.30 / $2,884.03
| Professional | | $1,258.93 | $2,089.30 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,162.28 / $4,073.80
| Professional | | $1,513.56 | $3,162.28 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,290.87 / $6,760.83
| Facility | | $1,318.26 | $2,290.87 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,570.40 / $10,471.29
| Professional | | $1,479.11 | $2,570.40 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,162.28 / $4,466.84
| Professional | | $2,754.23 | $3,162.28 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,090.30 / $4,466.84
| Professional | | $2,754.23 | $3,090.30 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,691.53 / $6,760.83
| Facility | | $1,995.26 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,511.89 / $3,467.37
| Professional | | $1,584.89 | $2,511.89 | $3,467.37 |