- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,630.78 / $9,549.93
| Facility | | $2,089.30 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,187.76 / $4,073.80
| Professional | | $1,819.70 | $2,187.76 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13,803.84 / $22,908.68 / $30,199.52
| Facility | | $13,803.84 | $22,908.68 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,570.40 / $3,715.35
| Professional | | $1,949.84 | $2,570.40 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,511.89 / $3,388.44
| Professional | | $1,995.26 | $2,511.89 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,511.89 / $4,570.88
| Professional | | $1,778.28 | $2,511.89 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,187.76 / $6,025.60
| Professional | | $1,819.70 | $2,187.76 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,162.28 / $4,677.35
| Professional | | $2,511.89 | $3,162.28 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,691.53 / $4,073.80
| Facility | | $1,949.84 | $2,691.53 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,630.27 / $8,511.38
| Facility | | $1,737.80 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,630.27 / $8,511.38
| Professional | | $1,737.80 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,311.31 / $6,309.57
| Facility | | $1,621.81 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,398.83 / $3,890.45
| Professional | | $1,621.81 | $2,398.83 | $3,890.45 |