- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $6,025.60 / $16,218.10
| Facility | | $1,047.13 | $6,025.60 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $1,949.84 / $7,244.36
| Professional | | $288.40 | $1,949.84 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $302.00 / $4,677.35
| Professional | | $288.40 | $302.00 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $6,760.83 / $12,022.64
| Facility | | $1,412.54 | $6,760.83 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $3,890.45 / $5,011.87
| Professional | | $309.03 | $3,890.45 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $7,244.36 / $8,709.64
| Facility | | $323.59 | $7,244.36 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $912.01 / $7,943.28
| Professional | | $302.00 | $912.01 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $13,489.63 / $23,442.29
| Facility | | $6,456.54 | $13,489.63 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,467.37 / $5,754.40
| Professional | | $3,235.94 | $3,467.37 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $5,011.87
| Professional | | $32.36 | $33.11 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $15,135.61 / $27,542.29
| Facility | | $6,025.60 | $15,135.61 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $3,630.78 / $8,709.64
| Professional | | $309.03 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $3,019.95 / $4,897.79
| Professional | | $234.42 | $3,019.95 | $4,897.79 |