- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $7,244.36 / $13,489.63
| Facility | | $3,162.28 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $1,513.56 / $3,162.28
| Professional | | $131.83 | $1,513.56 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,621.81 / $3,162.28
| Facility | | $1,230.27 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,318.26 / $3,019.95
| Professional | | $162.18 | $1,318.26 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,513.56 / $4,786.30
| Professional | | $316.23 | $1,513.56 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $2,754.23 / $8,709.64
| Facility | | $169.82 | $2,754.23 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,981.07 / $10,964.78
| Professional | | $2,398.83 | $3,981.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $3,388.44 / $5,248.07
| Professional | | $316.23 | $3,388.44 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $3,467.37
| Professional | | $316.23 | $316.23 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $575.44 / $5,248.07
| Professional | | $5.01 | $575.44 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,760.83 / $10,715.19
| Facility | | $3,630.78 | $6,760.83 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $2,187.76 / $4,570.88
| Professional | | $190.55 | $2,187.76 | $4,570.88 |