- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $7,943.28 / $14,454.40
| Facility | | $3,162.28 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,995.26 / $9,332.54
| Professional | | $1,621.81 | $1,995.26 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $11,220.18 / $21,877.62
| Facility | | $8,709.64 | $11,220.18 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,630.27 / $3,548.13
| Professional | | $1,548.82 | $2,630.27 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,981.07 / $5,370.32
| Professional | | $1,862.09 | $3,981.07 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,715.35 / $16,218.10
| Facility | | $1,621.81 | $3,715.35 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,630.78 / $13,182.57
| Professional | | $2,290.87 | $3,630.78 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $4,168.69 / $5,370.32
| Professional | | $3,801.89 | $4,168.69 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $3,801.89
| Professional | | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $3,311.31 / $4,365.16
| Professional | | $7.08 | $3,311.31 | $4,365.16 |
- 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
- $2,290.87 / $3,311.31 / $4,466.84
| Professional | | $2,290.87 | $3,311.31 | $4,466.84 |