- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,621.81 / $2,238.72
| Facility | | $1,288.25 | $1,621.81 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,621.81 / $2,951.21
| Professional | | $1,258.93 | $1,621.81 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,862.09 / $3,162.28
| Professional | | $1,230.27 | $1,862.09 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,659.59 / $2,570.40
| Professional | | $1,258.93 | $1,659.59 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,137.96 / $3,388.44
| Professional | | $1,348.96 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,995.26 / $2,344.23
| Professional | | $1,584.89 | $1,995.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,311.31 / $3,630.78
| Professional | | $2,630.27 | $3,311.31 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,041.74 / $3,162.28
| Facility | | $1,380.38 | $2,041.74 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $2,570.40
| Professional | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,949.84 / $9,549.93
| Facility | | $1,288.25 | $1,949.84 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,290.87 / $9,549.93
| Professional | | $1,548.82 | $2,290.87 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $10,471.29 / $21,379.62
| Facility | | $6,309.57 | $10,471.29 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,995.26 / $3,162.28
| Professional | | $1,202.26 | $1,995.26 | $3,162.28 |