- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,548.13 / $8,709.64
| Facility | | $1,445.44 | $3,548.13 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,513.56 / $2,884.03
| Professional | | $1,318.26 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $5,754.40
| Facility | | $5,623.41 | $5,623.41 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,698.24 / $4,265.80
| Professional | | $1,174.90 | $1,698.24 | $4,265.80 |
- 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
- $1,202.26 / $1,737.80 / $3,162.28
| Professional | | $1,202.26 | $1,737.80 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $3,388.44
| Professional | | $1,737.80 | $1,737.80 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,621.81 / $2,570.40
| Facility | | $1,318.26 | $1,621.81 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,511.89 / $3,162.28
| Professional | | $1,995.26 | $2,511.89 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $9,332.54 / $14,791.08
| Facility | | $3,467.37 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,445.44 / $3,090.30
| Professional | | $1,071.52 | $1,445.44 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $20,892.96 / $20,892.96
| Facility | | $1,995.26 | $20,892.96 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $10,471.29 / $12,589.25
| Professional | | $10,471.29 | $10,471.29 | $12,589.25 |