- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,570.40 / $8,709.64
| Facility | | $1,288.25 | $2,570.40 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,096.48 / $2,089.30
| Professional | | $954.99 | $1,096.48 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $1,819.70
| Facility | | $1,778.28 | $1,778.28 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,344.23 / $3,019.95
| Professional | | $1,174.90 | $2,344.23 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $2,187.76
| Facility | | $602.56 | $602.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,513.56 / $2,570.40
| Professional | | $1,071.52 | $1,513.56 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $2,454.71
| Professional | | $1,778.28 | $1,778.28 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,230.27 / $2,187.76
| Facility | | $1,023.29 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,659.59 / $2,041.74
| Professional | | $1,479.11 | $1,659.59 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $6,606.93 / $10,715.19
| Facility | | $2,187.76 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,230.27 / $2,187.76
| Professional | | $891.25 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $7,079.46 / $7,079.46
| Facility | | $56.23 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,585.78 / $7,585.78 / $9,120.11
| Professional | | $7,585.78 | $7,585.78 | $9,120.11 |