- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $4,073.80 / $12,589.25
| Facility | | $1,548.82 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $851.14 / $3,890.45
| Professional | | $630.96 | $851.14 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,890.45 / $7,585.78
| Facility | | $2,951.21 | $3,890.45 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,047.13 / $1,513.56
| Professional | | $630.96 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,479.11 / $1,995.26
| Professional | | $660.69 | $1,479.11 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,122.02 / $7,762.47
| Facility | | $630.96 | $1,122.02 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,174.90 / $5,011.87
| Professional | | $660.69 | $1,174.90 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,412.54 / $2,137.96
| Professional | | $1,318.26 | $1,412.54 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,479.11 / $2,137.96
| Professional | | $1,318.26 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,073.80 / $6,760.83
| Facility | | $2,630.27 | $4,073.80 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,122.02 / $1,659.59
| Professional | | $741.31 | $1,122.02 | $1,659.59 |