- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,454.71 / $8,709.64
| Facility | | $1,548.82 | $2,454.71 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,659.59 / $3,235.94
| Professional | | $1,412.54 | $1,659.59 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,238.72 / $4,168.69
| Professional | | $1,380.38 | $2,238.72 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $15,488.17
| Facility | | $602.56 | $602.56 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,137.96 / $3,801.89
| Professional | | $1,584.89 | $2,137.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $3,715.35
| Professional | | $2,454.71 | $2,454.71 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,041.74 / $3,235.94
| Facility | | $1,548.82 | $2,041.74 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,884.03 / $3,388.44
| Professional | | $2,398.83 | $2,884.03 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,890.45 / $6,760.83
| Facility | | $1,174.90 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,778.28 / $3,090.30
| Professional | | $1,318.26 | $1,778.28 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $9,772.37 / $9,772.37
| Facility | | $5,011.87 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $11,220.18 / $14,454.40
| Professional | | $11,220.18 | $11,220.18 | $14,454.40 |