- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $7,943.28 / $14,454.40
| Facility | | $4,570.88 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,630.27 / $4,677.35
| Professional | | $2,238.72 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15,848.93 / $20,892.96 / $40,738.03
| Facility | | $15,848.93 | $20,892.96 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,715.35 / $4,897.79
| Professional | | $2,187.76 | $3,715.35 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $4,786.30 / $7,943.28
| Professional | | $1,445.44 | $4,786.30 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,630.78 / $5,623.41
| Facility | | $2,238.72 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,897.79 / $18,620.87
| Professional | | $2,884.03 | $4,897.79 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $5,754.40 / $7,943.28
| Professional | | $4,677.35 | $5,754.40 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,786.30 / $7,943.28
| Professional | | $4,265.80 | $4,786.30 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $3,235.94 / $6,309.57
| Professional | | $15.14 | $3,235.94 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,466.84 / $8,128.31
| Facility | | $3,235.94 | $4,466.84 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,801.89 / $6,165.95
| Professional | | $2,884.03 | $3,801.89 | $6,165.95 |