- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $7,943.28 / $14,454.40
| Facility | | $2,951.21 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,698.24 / $4,365.16
| Professional | | $1,445.44 | $1,698.24 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,589.25 / $16,595.87 / $32,359.37
| Facility | | $12,589.25 | $16,595.87 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,344.23 / $3,162.28
| Professional | | $1,380.38 | $2,344.23 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,090.30 / $5,128.61
| Professional | | $776.25 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,344.23 / $4,365.16
| Facility | | $1,445.44 | $2,344.23 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,019.95 / $11,748.98
| Professional | | $1,778.28 | $3,019.95 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,630.78 / $5,128.61
| Professional | | $3,019.95 | $3,630.78 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,090.30 / $5,128.61
| Professional | | $2,691.53 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $2,344.23 / $4,073.80
| Professional | | $7.94 | $2,344.23 | $4,073.80 |
- 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
- $1,819.70 / $2,398.83 / $3,981.07
| Professional | | $1,819.70 | $2,398.83 | $3,981.07 |