- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $7,943.28 / $14,454.40
| Facility | | $3,311.31 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,862.09 / $3,388.44
| Professional | | $1,584.89 | $1,862.09 | $3,388.44 |
- 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
- $1,548.82 / $2,630.27 / $3,467.37
| Professional | | $1,548.82 | $2,630.27 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $3,388.44 / $5,623.41
| Professional | | $1,047.13 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,570.40 / $4,365.16
| Facility | | $1,584.89 | $2,570.40 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,311.31 / $13,182.57
| Professional | | $1,995.26 | $3,311.31 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,073.80 / $5,623.41
| Professional | | $3,311.31 | $4,073.80 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,388.44 / $5,623.41
| Professional | | $2,951.21 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $2,398.83 / $4,570.88
| Professional | | $10.96 | $2,398.83 | $4,570.88 |
- 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
- $1,995.26 / $2,630.27 / $4,365.16
| Professional | | $1,995.26 | $2,630.27 | $4,365.16 |