- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $2,570.40 / $4,786.30
| Facility | | $851.14 | $2,570.40 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,258.93 / $2,570.40
| Professional | | $1,122.02 | $1,258.93 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,230.27 / $1,479.11
| Professional | | $977.24 | $1,230.27 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,754.23 / $8,317.64
| Facility | | $1,380.38 | $2,754.23 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,380.38 / $2,238.72
| Professional | | $1,202.26 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,235.94 / $3,715.35
| Facility | | $2,818.38 | $3,235.94 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Professional | | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,479.11 / $2,884.03
| Facility | | $776.25 | $1,479.11 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $1,862.09
| Professional | | $1,230.27 | $1,230.27 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,238.72 / $2,570.40
| Professional | | $1,737.80 | $2,238.72 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,862.09 / $3,162.28
| Professional | | $1,412.54 | $1,862.09 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,162.28 / $3,162.28
| Facility | | $1,778.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,258.93 / $1,380.38
| Professional | | $1,202.26 | $1,258.93 | $1,380.38 |