- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $7,943.28 / $14,454.40
| Facility | | $3,388.44 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,949.84 / $3,467.37
| Professional | | $1,659.59 | $1,949.84 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $7,762.47 / $15,135.61
| Facility | | $6,025.60 | $7,762.47 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,691.53 / $3,630.78
| Professional | | $1,584.89 | $2,691.53 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $3,548.13 / $5,888.44
| Professional | | $1,258.93 | $3,548.13 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,691.53 / $4,365.16
| Facility | | $1,659.59 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,467.37 / $13,489.63
| Professional | | $1,995.26 | $3,467.37 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,168.69 / $5,888.44
| Professional | | $3,467.37 | $4,168.69 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,548.13 / $5,888.44
| Professional | | $3,090.30 | $3,548.13 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $1,862.09 / $4,677.35
| Professional | | $12.88 | $1,862.09 | $4,677.35 |
- 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
- $2,089.30 / $2,754.23 / $4,570.88
| Professional | | $2,089.30 | $2,754.23 | $4,570.88 |