- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,311.31 / $10,471.29
| Facility | | $2,511.89 | $3,311.31 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,511.89 / $4,073.80
| Professional | | $2,089.30 | $2,511.89 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $9,549.93 / $9,772.37
| Facility | | $6,918.31 | $9,549.93 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $2,041.74 / $5,011.87
| Professional | | $75.86 | $2,041.74 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $6,760.83 / $14,125.38
| Facility | | $2,344.23 | $6,760.83 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,479.11 / $4,168.69
| Professional | | $1,445.44 | $1,479.11 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,818.38 / $4,677.35
| Facility | | $2,454.71 | $2,818.38 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,174.90 / $1,174.90
| Professional | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $3,311.31
| Professional | | $3,090.30 | $3,090.30 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,715.35 / $3,801.89
| Facility | | $1,862.09 | $3,715.35 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,862.09 / $3,548.13
| Professional | | $1,318.26 | $1,862.09 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,791.08 / $14,791.08 / $14,791.08
| Facility | | $14,791.08 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15,488.17 / $15,488.17 / $23,442.29
| Professional | | $15,488.17 | $15,488.17 | $23,442.29 |