- 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 / $1,905.46 / $3,388.44
| Professional | | $1,584.89 | $1,905.46 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $7,244.36 / $14,125.38
| Facility | | $5,495.41 | $7,244.36 | $14,125.38 |
- 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
- $676.08 / $3,388.44 / $5,623.41
| Professional | | $676.08 | $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
- $3,019.95 / $3,388.44 / $5,623.41
| Professional | | $3,019.95 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $2,454.71 / $4,570.88
| Professional | | $7.08 | $2,454.71 | $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 / $2,691.53 / $4,466.84
| Professional | | $1,995.26 | $2,691.53 | $4,466.84 |