- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $7,943.28 / $14,454.40
| Facility | | $2,187.76 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,258.93 / $2,238.72
| Professional | | $1,071.52 | $1,258.93 | $2,238.72 |
- 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
- $1,023.29 / $1,737.80 / $2,344.23
| Professional | | $1,023.29 | $1,737.80 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,238.72 / $3,715.35
| Professional | | $676.08 | $2,238.72 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,737.80 / $3,715.35
| Facility | | $1,071.52 | $1,737.80 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,238.72 / $8,709.64
| Professional | | $1,258.93 | $2,238.72 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,691.53 / $3,715.35
| Professional | | $2,238.72 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,238.72 / $3,715.35
| Professional | | $1,995.26 | $2,238.72 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $1,621.81 / $3,019.95
| Professional | | $7.08 | $1,621.81 | $3,019.95 |
- 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
- $1,318.26 / $1,778.28 / $2,951.21
| Professional | | $1,318.26 | $1,778.28 | $2,951.21 |