- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $7,943.28 / $14,454.40
| Facility | | $2,630.27 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,479.11 / $2,630.27
| Professional | | $1,230.27 | $1,479.11 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,454.40 / $19,054.61 / $37,153.52
| Facility | | $14,454.40 | $19,054.61 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,995.26 / $2,691.53
| Professional | | $1,174.90 | $1,995.26 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,630.27 / $4,265.80
| Professional | | $1,318.26 | $2,630.27 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,995.26 / $3,981.07
| Facility | | $1,230.27 | $1,995.26 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,754.23 / $11,220.18
| Professional | | $1,584.89 | $2,754.23 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,162.28 / $4,265.80
| Professional | | $2,570.40 | $3,162.28 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,630.27 / $4,265.80
| Professional | | $2,344.23 | $2,630.27 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $1,949.84 / $3,467.37
| Professional | | $15.14 | $1,949.84 | $3,467.37 |
- 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
- $1,584.89 / $2,137.96 / $3,388.44
| Professional | | $1,584.89 | $2,137.96 | $3,388.44 |