- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $3,630.78 / $9,549.93
| Facility | | $1,380.38 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,778.28 / $2,818.38
| Professional | | $1,380.38 | $1,778.28 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $15,848.93 / $20,892.96
| Facility | | $8,709.64 | $15,848.93 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,089.30 / $3,019.95
| Professional | | $1,584.89 | $2,089.30 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,698.24 / $2,884.03
| Professional | | $776.25 | $1,698.24 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,137.96 / $3,388.44
| Professional | | $1,479.11 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,659.59 / $4,365.16
| Professional | | $1,412.54 | $1,659.59 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,818.38 / $3,890.45
| Professional | | $2,238.72 | $2,818.38 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,238.72 / $3,388.44
| Facility | | $1,412.54 | $2,238.72 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,187.76 / $7,585.78
| Facility | | $1,584.89 | $2,187.76 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,187.76 / $7,585.78
| Professional | | $1,584.89 | $2,187.76 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,311.31 / $6,309.57
| Facility | | $1,621.81 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,041.74 / $3,388.44
| Professional | | $1,348.96 | $2,041.74 | $3,388.44 |