- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $4,073.80 / $5,248.07
| Facility | | $1,584.89 | $4,073.80 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,584.89 / $2,570.40
| Professional | | $1,412.54 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $11,220.18 / $13,182.57
| Facility | | $8,511.38 | $11,220.18 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $36.31
| Professional | | $21.38 | $21.38 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,778.28 / $1,995.26
| Professional | | $1,621.81 | $1,778.28 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $5,248.07 / $10,964.78
| Facility | | $2,187.76 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,344.23 / $2,951.21
| Professional | | $2,137.96 | $2,344.23 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,041.74 / $3,630.78
| Facility | | $1,584.89 | $2,041.74 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,380.38
| Professional | | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,454.71 / $4,897.79
| Facility | | $1,584.89 | $2,454.71 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,454.71 / $4,897.79
| Professional | | $1,584.89 | $2,454.71 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,137.96 / $2,570.40
| Facility | | $1,288.25 | $2,137.96 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,071.52 / $2,344.23
| Professional | | $891.25 | $1,071.52 | $2,344.23 |