- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $9,549.93 / $15,848.93
| Facility | | $6,025.60 | $9,549.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,288.25 / $6,025.60
| Professional | | $1,023.29 | $1,288.25 | $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
- $977.24 / $1,698.24 / $2,454.71
| Professional | | $977.24 | $1,698.24 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,511.89 / $3,388.44
| Professional | | $1,230.27 | $2,511.89 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,454.71 / $17,378.01
| Facility | | $1,318.26 | $2,454.71 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,290.87 / $8,912.51
| Professional | | $1,412.54 | $2,290.87 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,570.40 / $3,467.37
| Professional | | $2,454.71 | $2,570.40 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,398.83
| Professional | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $1,862.09 / $2,818.38
| Professional | | $6.03 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $9,332.54 / $16,218.10
| Facility | | $7,079.46 | $9,332.54 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,089.30 / $2,818.38
| Professional | | $1,412.54 | $2,089.30 | $2,818.38 |