- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,884.03 / $9,120.11
| Facility | | $2,344.23 | $2,884.03 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,548.13 / $4,897.79
| Professional | | $2,398.83 | $3,548.13 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $6,309.57 / $8,709.64
| Facility | | $5,248.07 | $6,309.57 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,454.71 / $4,365.16
| Professional | | $1,230.27 | $2,454.71 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $5,888.44 / $12,302.69
| Facility | | $2,041.74 | $5,888.44 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,288.25 / $3,630.78
| Professional | | $1,258.93 | $1,288.25 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,090.30 / $4,786.30
| Facility | | $2,454.71 | $3,090.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $2,691.53
| Professional | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $2,884.03
| Professional | | $2,691.53 | $2,691.53 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,162.28 / $3,311.31
| Facility | | $1,621.81 | $3,162.28 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,621.81 / $3,090.30
| Professional | | $1,148.15 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,882.50 / $12,882.50 / $12,882.50
| Facility | | $12,882.50 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13,489.63 / $13,489.63 / $20,417.38
| Professional | | $13,489.63 | $13,489.63 | $20,417.38 |