- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $7,943.28 / $14,454.40
| Facility | | $2,884.03 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,659.59 / $2,884.03
| Professional | | $1,380.38 | $1,659.59 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $14,791.08 / $28,840.32
| Facility | | $11,220.18 | $14,791.08 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,238.72 / $3,019.95
| Professional | | $1,318.26 | $2,238.72 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,951.21 / $4,897.79
| Professional | | $1,412.54 | $2,951.21 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,398.83 / $4,365.16
| Facility | | $1,380.38 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,090.30 / $12,302.69
| Professional | | $1,819.70 | $3,090.30 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,548.13 / $4,897.79
| Professional | | $2,884.03 | $3,548.13 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,019.95 / $4,897.79
| Professional | | $2,630.27 | $3,019.95 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $3,090.30 / $3,890.45
| Professional | | $15.14 | $3,090.30 | $3,890.45 |
- 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
- $1,819.70 / $2,454.71 / $3,890.45
| Professional | | $1,819.70 | $2,454.71 | $3,890.45 |