- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $5,011.87 / $12,589.25
| Facility | | $2,344.23 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,445.44 / $5,370.32
| Professional | | $912.01 | $1,445.44 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $8,912.51 / $17,378.01
| Facility | | $6,760.83 | $8,912.51 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,548.82 / $2,187.76
| Professional | | $912.01 | $1,548.82 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $6,309.57
| Facility | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $2,290.87 / $2,884.03
| Professional | | $1,047.13 | $2,290.87 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,659.59 / $9,549.93
| Facility | | $912.01 | $1,659.59 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,862.09 / $7,413.10
| Professional | | $1,047.13 | $1,862.09 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,290.87 / $3,090.30
| Professional | | $1,905.46 | $2,290.87 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $6,309.57
| Facility | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,187.76 / $3,090.30
| Professional | | $1,905.46 | $2,187.76 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $7,585.78 / $13,182.57
| Facility | | $6,309.57 | $7,585.78 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,778.28 / $2,570.40
| Professional | | $1,122.02 | $1,778.28 | $2,570.40 |