- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $4,897.79 / $13,182.57
| Facility | | $1,148.15 | $4,897.79 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,445.44 / $2,454.71
| Professional | | $1,148.15 | $1,445.44 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,122.02
| Professional | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $4,677.35 / $11,220.18
| Facility | | $1,318.26 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,348.96 / $1,659.59
| Professional | | $1,202.26 | $1,348.96 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,884.03 / $3,467.37
| Facility | | $691.83 | $2,884.03 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,659.59 / $2,691.53
| Professional | | $1,122.02 | $1,659.59 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $13,489.63 / $23,988.33
| Facility | | $6,456.54 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,122.02 / $1,412.54
| Professional | | $1,047.13 | $1,122.02 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,819.70
| Professional | | $32.36 | $33.11 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $9,549.93 / $15,848.93
| Facility | | $3,311.31 | $9,549.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,584.89 / $2,884.03
| Professional | | $1,071.52 | $1,584.89 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,148.15 / $1,548.82
| Professional | | $933.25 | $1,148.15 | $1,548.82 |