- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,290.87 / $2,630.27
| Facility | | $1,318.26 | $2,290.87 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,148.15 / $2,238.72
| Professional | | $831.76 | $1,148.15 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $4,677.35
| Facility | | $1,348.96 | $1,348.96 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $891.25 / $2,398.83
| Professional | | $537.03 | $891.25 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $1,995.26 / $3,548.13
| Facility | | $1,862.09 | $1,995.26 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,348.96 / $1,513.56
| Professional | | $954.99 | $1,348.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,570.40 / $3,311.31
| Facility | | $1,380.38 | $2,570.40 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,288.25 / $1,949.84
| Professional | | $616.60 | $1,288.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,698.24 / $6,456.54
| Facility | | $1,096.48 | $1,698.24 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $812.83 / $6,760.83
| Professional | | $562.34 | $812.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,348.96 / $1,621.81
| Facility | | $562.34 | $1,348.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $812.83 / $1,621.81
| Professional | | $562.34 | $812.83 | $1,621.81 |