- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,737.80 / $2,089.30
| Facility | | $1,659.59 | $1,737.80 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,230.27 / $1,819.70
| Professional | | $891.25 | $1,230.27 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $2,454.71
| Facility | | $1,288.25 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,884.03 / $3,630.78
| Professional | | $1,288.25 | $2,884.03 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,511.89 / $2,691.53
| Professional | | $2,089.30 | $2,511.89 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,884.03 / $10,964.78
| Facility | | $1,513.56 | $2,884.03 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,548.82 / $3,715.35
| Professional | | $1,047.13 | $1,548.82 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,511.89 / $3,162.28
| Professional | | $2,398.83 | $2,511.89 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,715.35 / $3,715.35
| Professional | | $2,398.83 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,238.72 / $5,495.41
| Facility | | $1,023.29 | $2,238.72 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,202.26 / $2,089.30
| Professional | | $1,023.29 | $1,202.26 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,187.76 / $2,187.76
| Professional | | $1,698.24 | $2,187.76 | $2,187.76 |