- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $7,943.28 / $14,454.40
| Facility | | $3,801.89 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,089.30 / $10,964.78
| Professional | | $1,778.28 | $2,089.30 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $10,964.78 / $21,379.62
| Facility | | $8,511.38 | $10,964.78 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,951.21 / $3,981.07
| Professional | | $1,737.80 | $2,951.21 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $4,466.84 / $5,888.44
| Professional | | $2,290.87 | $4,466.84 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,715.35 / $28,840.32
| Facility | | $1,778.28 | $3,715.35 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,981.07 / $14,791.08
| Professional | | $2,398.83 | $3,981.07 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $4,677.35 / $6,456.54
| Professional | | $4,570.88 | $4,677.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $3,388.44 / $5,248.07
| Professional | | $10.96 | $3,388.44 | $5,248.07 |
- 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
- $2,511.89 / $3,548.13 / $4,786.30
| Professional | | $2,511.89 | $3,548.13 | $4,786.30 |