- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $5,011.87 / $12,589.25
| Facility | | $2,041.74 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,071.52 / $5,495.41
| Professional | | $933.25 | $1,071.52 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $12,882.50 / $25,118.86
| Facility | | $9,772.37 | $12,882.50 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,479.11 / $2,041.74
| Professional | | $912.01 | $1,479.11 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $2,344.23 / $3,090.30
| Professional | | $1,071.52 | $2,344.23 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,187.76 / $7,943.28
| Facility | | $1,174.90 | $2,187.76 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,089.30 / $7,585.78
| Professional | | $1,318.26 | $2,089.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,398.83 / $3,090.30
| Professional | | $2,238.72 | $2,398.83 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Professional | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $1,548.82 / $2,511.89
| Professional | | $7.08 | $1,548.82 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,630.78 / $6,760.83
| Facility | | $2,570.40 | $3,630.78 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,905.46 / $2,570.40
| Professional | | $1,318.26 | $1,905.46 | $2,570.40 |