- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,466.84 / $5,495.41
| Facility | | $3,388.44 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,202.26 / $2,041.74
| Professional | | $812.83 | $1,202.26 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $4,570.88 / $8,511.38
| Facility | | $1,995.26 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,698.24 / $1,778.28
| Professional | | $1,479.11 | $1,698.24 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,174.90 / $1,548.82
| Professional | | $812.83 | $1,174.90 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,479.11 / $2,238.72
| Facility | | $870.96 | $1,479.11 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,584.89 / $2,137.96
| Professional | | $1,412.54 | $1,584.89 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $7,244.36 / $10,232.93
| Facility | | $5,754.40 | $7,244.36 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,737.80 / $1,905.46
| Professional | | $1,288.25 | $1,737.80 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,023.29 / $6,309.57
| Professional | | $776.25 | $1,023.29 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $9,332.54 / $18,197.01
| Facility | | $1,513.56 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,288.25 / $1,819.70
| Professional | | $870.96 | $1,288.25 | $1,819.70 |