- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $7,943.28 / $14,454.40
| Facility | | $2,454.71 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,412.54 / $2,511.89
| Professional | | $1,202.26 | $1,412.54 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $11,481.54 / $22,387.21
| Facility | | $8,912.51 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,949.84 / $2,630.27
| Professional | | $1,148.15 | $1,949.84 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,570.40 / $4,265.80
| Professional | | $676.08 | $2,570.40 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,949.84 / $3,890.45
| Facility | | $1,202.26 | $1,949.84 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,511.89 / $9,772.37
| Professional | | $1,445.44 | $2,511.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,019.95 / $4,265.80
| Professional | | $2,511.89 | $3,019.95 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,570.40 / $4,265.80
| Professional | | $2,238.72 | $2,570.40 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $1,778.28 / $3,388.44
| Professional | | $7.08 | $1,778.28 | $3,388.44 |
- 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
- $1,513.56 / $1,995.26 / $3,311.31
| Professional | | $1,513.56 | $1,995.26 | $3,311.31 |