- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $3,548.13 / $4,570.88
| Facility | | $1,412.54 | $3,548.13 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,412.54 / $2,238.72
| Professional | | $1,230.27 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $9,772.37 / $11,748.98
| Facility | | $7,413.10 | $9,772.37 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $363.08
| Professional | | $208.93 | $208.93 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,584.89 / $1,737.80
| Professional | | $1,445.44 | $1,584.89 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $4,466.84 / $9,549.93
| Facility | | $1,202.26 | $4,466.84 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,041.74 / $2,630.27
| Professional | | $1,862.09 | $2,041.74 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,819.70 / $3,162.28
| Facility | | $1,412.54 | $1,819.70 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,202.26
| Professional | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,137.96 / $3,801.89
| Facility | | $1,318.26 | $2,137.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,137.96 / $3,890.45
| Professional | | $1,318.26 | $2,137.96 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,862.09 / $2,238.72
| Facility | | $1,122.02 | $1,862.09 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $933.25 / $2,041.74
| Professional | | $776.25 | $933.25 | $2,041.74 |