- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,818.38 / $10,964.78
| Facility | | $1,023.29 | $2,818.38 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,096.48 / $2,454.71
| Professional | | $954.99 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,949.84 / $2,818.38
| Professional | | $1,230.27 | $1,949.84 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $6,309.57
| Facility | | $602.56 | $602.56 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,479.11 / $2,570.40
| Professional | | $1,047.13 | $1,479.11 | $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 / $1,348.96 / $2,137.96
| Facility | | $1,023.29 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,862.09 / $2,238.72
| Professional | | $1,479.11 | $1,862.09 | $2,238.72 |
- 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
- $870.96 / $1,174.90 / $2,187.76
| Professional | | $870.96 | $1,174.90 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20,892.96 / $20,892.96 / $33,884.42
| Facility | | $20,892.96 | $20,892.96 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,762.47 / $7,762.47 / $9,120.11
| Professional | | $7,762.47 | $7,762.47 | $9,120.11 |