- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,951.21 / $11,220.18
| Facility | | $1,862.09 | $2,951.21 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $2,137.96 / $3,388.44
| Professional | | $416.87 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,122.02
| Professional | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,951.21 / $3,467.37
| Facility | | $2,570.40 | $2,951.21 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $2,951.21 / $2,951.21
| Professional | | $10.96 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,454.71 / $11,748.98
| Facility | | $1,659.59 | $2,454.71 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,344.23 / $5,011.87
| Professional | | $1,380.38 | $2,344.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $3,467.37
| Professional | | $1,737.80 | $1,737.80 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,905.46 / $2,630.27
| Professional | | $1,737.80 | $1,905.46 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,778.28 / $2,951.21
| Facility | | $1,230.27 | $1,778.28 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,230.27 / $3,548.13
| Professional | | $1,023.29 | $1,230.27 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $2,951.21
| Professional | | $1,737.80 | $1,737.80 | $2,951.21 |