- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,801.89 / $10,471.29
| Facility | | $1,513.56 | $3,801.89 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,148.15 / $2,884.03
| Professional | | $933.25 | $1,148.15 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $10,715.19
| Facility | | $7,413.10 | $7,413.10 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,187.76 / $3,162.28
| Professional | | $1,202.26 | $2,187.76 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,479.11 / $2,398.83
| Professional | | $1,071.52 | $1,479.11 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $2,344.23
| Professional | | $1,778.28 | $1,778.28 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,412.54 / $2,238.72
| Facility | | $1,000.00 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,819.70 / $2,137.96
| Professional | | $1,479.11 | $1,819.70 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $14,791.08 / $23,442.29
| Facility | | $5,623.41 | $14,791.08 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,174.90 / $2,137.96
| Professional | | $870.96 | $1,174.90 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $26,302.68 / $26,302.68
| Facility | | $56.23 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,232.93 / $11,481.54 / $11,481.54
| Professional | | $10,232.93 | $11,481.54 | $11,481.54 |