- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,630.78 / $9,549.93
| Facility | | $1,621.81 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,621.81 / $2,630.27
| Professional | | $1,412.54 | $1,621.81 | $2,630.27 |
- 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
- $1,513.56 / $1,995.26 / $2,884.03
| Professional | | $1,513.56 | $1,995.26 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,949.84 / $2,691.53
| Professional | | $1,584.89 | $1,949.84 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,949.84 / $3,548.13
| Professional | | $1,318.26 | $1,949.84 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,737.80 / $4,677.35
| Professional | | $1,445.44 | $1,737.80 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,511.89 / $3,630.78
| Professional | | $1,995.26 | $2,511.89 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,089.30 / $3,162.28
| Facility | | $1,513.56 | $2,089.30 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,041.74 / $6,760.83
| Facility | | $1,380.38 | $2,041.74 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,041.74 / $6,760.83
| Professional | | $1,380.38 | $2,041.74 | $6,760.83 |
- 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
- $1,288.25 / $1,905.46 / $3,019.95
| Professional | | $1,288.25 | $1,905.46 | $3,019.95 |