- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $7,943.28 / $14,454.40
| Facility | | $2,041.74 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,202.26 / $2,570.40
| Professional | | $1,000.00 | $1,202.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,589.25 / $16,595.87 / $32,359.37
| Facility | | $12,589.25 | $16,595.87 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,621.81 / $2,137.96
| Professional | | $954.99 | $1,621.81 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,089.30 / $3,467.37
| Professional | | $758.58 | $2,089.30 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,584.89 / $3,715.35
| Facility | | $977.24 | $1,584.89 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,041.74 / $8,128.31
| Professional | | $1,174.90 | $2,041.74 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,454.71 / $3,467.37
| Professional | | $2,041.74 | $2,454.71 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,089.30 / $3,467.37
| Professional | | $1,819.70 | $2,089.30 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $1,548.82 / $2,754.23
| Professional | | $7.94 | $1,548.82 | $2,754.23 |
- 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
- $1,230.27 / $1,621.81 / $2,691.53
| Professional | | $1,230.27 | $1,621.81 | $2,691.53 |