- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $17,782.79
| Facility | | $1,288.25 | $1,288.25 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,041.74 / $2,454.71
| Professional | | $1,288.25 | $2,041.74 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $15,135.61 / $26,302.68
| Facility | | $5,248.07 | $15,135.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $4,677.35 / $12,302.69
| Professional | | $2,137.96 | $4,677.35 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,041.74 / $3,162.28
| Facility | | $1,288.25 | $2,041.74 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,691.53 / $7,762.47
| Facility | | $1,513.56 | $2,691.53 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,890.45 / $16,218.10
| Professional | | $2,344.23 | $3,890.45 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $58.88 / $70.79
| Professional | | $50.12 | $58.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $5,370.32 / $7,413.10
| Professional | | $2,951.21 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $40,738.03
| Facility | | $5,623.41 | $5,623.41 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $15,848.93 / $15,848.93
| Professional | | $8,912.51 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $7,244.36 / $20,892.96
| Facility | | $2,290.87 | $7,244.36 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,311.31 / $8,709.64
| Professional | | $2,290.87 | $3,311.31 | $8,709.64 |