- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,265.80 / $7,585.78 / $14,454.40
| Facility | | $4,265.80 | $7,585.78 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,412.54 / $5,128.61
| Professional | | $851.14 | $1,412.54 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,128.61 / $6,606.93 / $12,882.50
| Facility | | $5,128.61 | $6,606.93 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,412.54 / $1,862.09
| Professional | | $851.14 | $1,412.54 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,137.96 / $2,818.38
| Professional | | $1,778.28 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,995.26 / $6,456.54
| Facility | | $870.96 | $1,995.26 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,778.28 / $2,570.40
| Professional | | $1,258.93 | $1,778.28 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,137.96 / $2,818.38
| Professional | | $1,778.28 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,041.74 / $2,818.38
| Professional | | $1,778.28 | $2,041.74 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,715.35 / $6,760.83
| Facility | | $2,951.21 | $3,715.35 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,778.28 / $2,290.87
| Professional | | $1,096.48 | $1,778.28 | $2,290.87 |