- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $4,570.88 / $8,317.64
| Facility | | $1,380.38 | $4,570.88 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,318.26 / $2,454.71
| Professional | | $1,148.15 | $1,318.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,511.89 / $3,630.78
| Professional | | $1,412.54 | $2,511.89 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $5,623.41
| Facility | | $602.56 | $602.56 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,737.80 / $3,090.30
| Professional | | $1,230.27 | $1,737.80 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,884.03
| Professional | | $2,041.74 | $2,041.74 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,659.59 / $2,630.27
| Facility | | $1,230.27 | $1,659.59 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,137.96 / $2,818.38
| Professional | | $1,698.24 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $11,748.98 / $19,498.45
| Facility | | $5,370.32 | $11,748.98 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,445.44 / $2,570.40
| Professional | | $1,071.52 | $1,445.44 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29,512.09 / $29,512.09 / $45,708.82
| Facility | | $29,512.09 | $29,512.09 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $9,120.11 / $10,715.19
| Professional | | $9,120.11 | $9,120.11 | $10,715.19 |