- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $4,073.80 / $12,589.25
| Facility | | $2,137.96 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,230.27 / $6,025.60
| Professional | | $1,023.29 | $1,230.27 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $12,589.25 / $24,547.09
| Facility | | $9,772.37 | $12,589.25 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,621.81 / $2,238.72
| Professional | | $1,000.00 | $1,621.81 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,570.40 / $3,388.44
| Professional | | $1,202.26 | $2,570.40 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,778.28 / $6,165.95
| Facility | | $489.78 | $1,778.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,290.87 / $8,317.64
| Professional | | $1,445.44 | $2,290.87 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,570.40 / $3,630.78
| Professional | | $2,454.71 | $2,570.40 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Professional | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $1,819.70 / $2,951.21
| Professional | | $6.03 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,548.82 / $5,248.07
| Facility | | $295.12 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,089.30 / $2,818.38
| Professional | | $1,445.44 | $2,089.30 | $2,818.38 |