- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $7,943.28 / $14,454.40
| Facility | | $2,089.30 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,412.54 / $6,456.54
| Professional | | $1,096.48 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $5,495.41 / $10,715.19
| Facility | | $4,168.69 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,778.28 / $2,398.83
| Professional | | $1,071.52 | $1,778.28 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,754.23 / $3,548.13
| Professional | | $1,230.27 | $2,754.23 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $2,454.71 / $26,915.35
| Facility | | $1,096.48 | $2,454.71 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,398.83 / $9,772.37
| Professional | | $1,584.89 | $2,398.83 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,754.23 / $3,630.78
| Professional | | $2,630.27 | $2,754.23 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $2,630.27
| Professional | | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $2,238.72 / $2,951.21
| Professional | | $18.20 | $2,238.72 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,466.84 / $8,128.31
| Facility | | $3,235.94 | $4,466.84 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,137.96 / $2,951.21
| Professional | | $1,548.82 | $2,137.96 | $2,951.21 |