- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,479.11 / $1,479.11
| Facility | | $1,445.44 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,479.11 / $2,187.76
| Professional | | $1,288.25 | $1,479.11 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $2,951.21
| Facility | | $2,818.38 | $2,818.38 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $3,630.78
| Professional | | $1,737.80 | $1,737.80 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,949.84
| Professional | | $1,479.11 | $1,479.11 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,089.30 / $2,089.30
| Facility | | $1,412.54 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,513.56 / $1,819.70
| Professional | | $1,513.56 | $1,513.56 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,818.38 / $3,890.45
| Professional | | $2,089.30 | $2,818.38 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,819.70 / $2,754.23
| Professional | | $1,737.80 | $1,819.70 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,041.74 / $3,467.37
| Facility | | $1,202.26 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,737.80 / $1,819.70
| Professional | | $1,513.56 | $1,737.80 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,290.87 / $5,754.40
| Facility | | $1,513.56 | $2,290.87 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,290.87 / $5,754.40
| Professional | | $1,513.56 | $2,290.87 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $2,041.74 / $2,818.38
| Facility | | $1,047.13 | $2,041.74 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,380.38 / $2,187.76
| Professional | | $1,318.26 | $1,380.38 | $2,187.76 |