- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,630.78 / $6,918.31
| Facility | | $1,513.56 | $3,630.78 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,071.52 / $3,311.31
| Professional | | $851.14 | $1,071.52 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $4,897.79 / $16,982.44
| Facility | | $1,905.46 | $4,897.79 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,445.44 / $9,772.37
| Professional | | $891.25 | $1,445.44 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,862.09 / $2,570.40
| Professional | | $1,737.80 | $1,862.09 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,023.29 / $6,456.54
| Facility | | $954.99 | $1,023.29 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,230.27 / $2,570.40
| Professional | | $512.86 | $1,230.27 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,202.26 / $3,311.31
| Facility | | $776.25 | $1,202.26 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,122.02 / $1,659.59
| Professional | | $776.25 | $1,122.02 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $5,011.87 / $13,182.57
| Facility | | $776.25 | $5,011.87 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,548.82 / $2,398.83
| Professional | | $870.96 | $1,548.82 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $4,897.79 / $16,982.44
| Facility | | $1,905.46 | $4,897.79 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,445.44 / $9,772.37
| Professional | | $891.25 | $1,445.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $4,897.79 / $13,182.57
| Facility | | $1,122.02 | $4,897.79 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,445.44 / $2,691.53
| Professional | | $912.01 | $1,445.44 | $2,691.53 |