- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $6,918.31 / $13,803.84
| Facility | | $1,778.28 | $6,918.31 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,949.84 / $3,630.78
| Professional | | $1,659.59 | $1,949.84 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,877.62 / $21,877.62 / $31,622.78
| Facility | | $21,877.62 | $21,877.62 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,818.38 / $5,248.07
| Professional | | $2,089.30 | $2,818.38 | $5,248.07 |
- 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
- $1,819.70 / $2,511.89 / $4,073.80
| Professional | | $1,819.70 | $2,511.89 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $4,168.69
| Professional | | $3,090.30 | $3,090.30 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,398.83 / $3,715.35
| Facility | | $1,778.28 | $2,398.83 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,311.31 / $3,890.45
| Professional | | $2,630.27 | $3,311.31 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $21,379.62 / $30,902.95
| Facility | | $9,549.93 | $21,379.62 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,995.26 / $3,801.89
| Professional | | $1,548.82 | $1,995.26 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $77,624.71 / $77,624.71
| Facility | | $56.23 | $77,624.71 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19,498.45 / $19,498.45 / $19,498.45
| Professional | | $19,498.45 | $19,498.45 | $19,498.45 |