- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $3,467.37 / $11,481.54
| Facility | | $1,288.25 | $3,467.37 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $977.24 / $1,862.09
| Professional | | $851.14 | $977.24 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $2,041.74 / $2,691.53
| Professional | | $1,096.48 | $2,041.74 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $18,197.01
| Facility | | $851.14 | $851.14 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,288.25 / $2,041.74
| Professional | | $954.99 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $2,187.76
| Professional | | $1,584.89 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,258.93 / $1,949.84
| Facility | | $912.01 | $1,258.93 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,659.59 / $1,949.84
| Professional | | $1,288.25 | $1,659.59 | $1,949.84 |
- 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
- $776.25 / $1,023.29 / $1,949.84
| Professional | | $776.25 | $1,023.29 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42,657.95 / $63,095.73 / $63,095.73
| Facility | | $42,657.95 | $63,095.73 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $6,760.83 / $8,128.31
| Professional | | $6,760.83 | $6,760.83 | $8,128.31 |