- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $7,585.78 / $12,022.64
| Facility | | $1,348.96 | $7,585.78 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,096.48 / $2,691.53
| Professional | | $851.14 | $1,096.48 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,235.94 / $3,630.78
| Facility | | $2,818.38 | $3,235.94 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,479.11 / $2,691.53
| Professional | | $977.24 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $3,388.44 / $5,370.32
| Facility | | $501.19 | $3,388.44 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,230.27 / $2,238.72
| Professional | | $831.76 | $1,230.27 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,479.11
| Professional | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,148.15 / $1,819.70
| Facility | | $870.96 | $1,148.15 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $2,454.71
| Professional | | $977.24 | $977.24 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,047.13 / $1,047.13
| Professional | | $977.24 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $8,317.64 / $16,982.44
| Facility | | $1,584.89 | $8,317.64 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,023.29 / $1,819.70
| Professional | | $758.58 | $1,023.29 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16,982.44 / $16,982.44 / $42,657.95
| Facility | | $16,982.44 | $16,982.44 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $9,772.37 / $9,772.37
| Professional | | $8,912.51 | $9,772.37 | $9,772.37 |