- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $3,467.37 / $14,454.40
| Facility | | $1,174.90 | $3,467.37 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $891.25 / $1,778.28
| Professional | | $776.25 | $891.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,096.48 / $2,630.27
| Professional | | $891.25 | $1,096.48 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,174.90 / $2,511.89
| Facility | | $1,174.90 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,174.90 / $1,949.84
| Professional | | $831.76 | $1,174.90 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $1,995.26
| Professional | | $1,445.44 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,122.02 / $1,862.09
| Facility | | $831.76 | $1,122.02 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,584.89 / $1,905.46
| Professional | | $1,348.96 | $1,584.89 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $6,918.31 / $10,715.19
| Facility | | $2,344.23 | $6,918.31 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $954.99 / $1,819.70
| Professional | | $724.44 | $954.99 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $8,317.64 / $33,884.42
| Facility | | $8,317.64 | $8,317.64 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $8,912.51 / $8,912.51
| Professional | | $8,912.51 | $8,912.51 | $8,912.51 |