- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $3,090.30 / $14,454.40
| Facility | | $1,148.15 | $3,090.30 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $891.25 / $1,949.84
| Professional | | $758.58 | $891.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $3,548.13
| Facility | | $3,467.37 | $3,467.37 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,122.02 / $2,398.83
| Professional | | $933.25 | $1,122.02 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,174.90 / $6,760.83
| Facility | | $1,174.90 | $1,174.90 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,122.02 / $1,995.26
| Professional | | $851.14 | $1,122.02 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,949.84
| Professional | | $1,318.26 | $1,318.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,096.48 / $1,737.80
| Facility | | $831.76 | $1,096.48 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,445.44 / $1,819.70
| Professional | | $1,148.15 | $1,445.44 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $11,748.98 / $19,498.45
| Facility | | $4,677.35 | $11,748.98 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $912.01 / $1,778.28
| Professional | | $707.95 | $912.01 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $33,884.42
| Facility | | $21,379.62 | $21,379.62 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15,135.61 / $15,135.61 / $15,135.61
| Professional | | $15,135.61 | $15,135.61 | $15,135.61 |