- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $6,918.31 / $13,803.84
| Facility | | $2,089.30 | $6,918.31 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,238.72 / $4,365.16
| Professional | | $1,949.84 | $2,238.72 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,791.08 / $14,791.08 / $21,379.62
| Facility | | $14,791.08 | $14,791.08 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $4,570.88 / $6,165.95
| Professional | | $2,398.83 | $4,570.88 | $6,165.95 |
- 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
- $2,137.96 / $2,951.21 / $4,786.30
| Professional | | $2,137.96 | $2,951.21 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $4,897.79
| Professional | | $3,715.35 | $3,715.35 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,884.03 / $4,466.84
| Facility | | $2,089.30 | $2,884.03 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,630.78 / $4,677.35
| Professional | | $2,818.38 | $3,630.78 | $4,677.35 |
- 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
- $1,819.70 / $2,454.71 / $4,570.88
| Professional | | $1,819.70 | $2,454.71 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $52,480.75 / $52,480.75
| Facility | | $56.23 | $52,480.75 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32,359.37 / $32,359.37 / $32,359.37
| Professional | | $32,359.37 | $32,359.37 | $32,359.37 |