- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $17,782.79
| Facility | | $1,318.26 | $1,318.26 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,187.76 / $2,511.89
| Professional | | $1,318.26 | $2,187.76 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $16,218.10 / $26,302.68
| Facility | | $11,748.98 | $16,218.10 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $4,897.79 / $12,589.25
| Professional | | $2,187.76 | $4,897.79 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,089.30 / $3,311.31
| Facility | | $1,318.26 | $2,089.30 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,691.53 / $7,762.47
| Facility | | $1,548.82 | $2,691.53 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,981.07 / $16,982.44
| Professional | | $2,398.83 | $3,981.07 | $16,982.44 |
- 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
- $3,090.30 / $5,495.41 / $7,585.78
| Professional | | $3,090.30 | $5,495.41 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $5,754.40 / $41,686.94
| Facility | | $5,754.40 | $5,754.40 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $16,595.87 / $16,595.87
| Professional | | $9,332.54 | $16,595.87 | $16,595.87 |
- 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
- $2,398.83 / $3,467.37 / $8,912.51
| Professional | | $2,398.83 | $3,467.37 | $8,912.51 |