- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $4,365.16 / $11,481.54
| Facility | | $1,621.81 | $4,365.16 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,230.27 / $2,398.83
| Professional | | $1,071.52 | $1,230.27 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $10,715.19
| Facility | | $7,413.10 | $7,413.10 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,905.46 / $3,388.44
| Professional | | $1,380.38 | $1,905.46 | $3,388.44 |
- 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 / $1,621.81 / $2,570.40
| Professional | | $1,202.26 | $1,621.81 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $2,754.23
| Professional | | $1,995.26 | $1,995.26 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,621.81 / $2,511.89
| Facility | | $1,148.15 | $1,621.81 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,290.87 / $2,818.38
| Professional | | $1,819.70 | $2,290.87 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $14,791.08 / $23,442.29
| Facility | | $5,623.41 | $14,791.08 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,318.26 / $2,454.71
| Professional | | $977.24 | $1,318.26 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $26,302.68 / $26,302.68
| Facility | | $56.23 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $8,709.64 / $10,232.93
| Professional | | $8,709.64 | $8,709.64 | $10,232.93 |