- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $5,011.87 / $12,589.25
| Facility | | $1,148.15 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $912.01 / $4,265.80
| Professional | | $741.31 | $912.01 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,232.93 / $13,489.63 / $26,302.68
| Facility | | $10,232.93 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,202.26 / $1,778.28
| Professional | | $707.95 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,819.70 / $2,454.71
| Professional | | $851.14 | $1,819.70 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,737.80 / $8,912.51
| Facility | | $933.25 | $1,737.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,659.59 / $5,888.44
| Professional | | $1,047.13 | $1,659.59 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,862.09 / $2,454.71
| Professional | | $1,737.80 | $1,862.09 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $1,737.80
| Professional | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $1,479.11 / $1,995.26
| Professional | | $3.02 | $1,479.11 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,918.31 / $9,120.11
| Facility | | $6,309.57 | $6,918.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,513.56 / $1,995.26
| Professional | | $1,047.13 | $1,513.56 | $1,995.26 |