- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $7,943.28 / $14,454.40
| Facility | | $2,187.76 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,258.93 / $3,162.28
| Professional | | $1,047.13 | $1,258.93 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $7,762.47 / $15,135.61
| Facility | | $6,025.60 | $7,762.47 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,698.24 / $2,290.87
| Professional | | $1,000.00 | $1,698.24 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,238.72 / $3,715.35
| Professional | | $676.08 | $2,238.72 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,698.24 / $3,715.35
| Facility | | $1,047.13 | $1,698.24 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,187.76 / $8,511.38
| Professional | | $1,230.27 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,630.27 / $3,715.35
| Professional | | $2,187.76 | $2,630.27 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,238.72 / $3,715.35
| Professional | | $1,949.84 | $2,238.72 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $1,380.38 / $2,951.21
| Professional | | $7.08 | $1,380.38 | $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
- $1,288.25 / $1,737.80 / $2,884.03
| Professional | | $1,288.25 | $1,737.80 | $2,884.03 |