- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,698.24 / $1,819.70
| Facility | | $1,584.89 | $1,698.24 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,122.02 / $1,819.70
| Professional | | $912.01 | $1,122.02 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $2,398.83
| Facility | | $1,202.26 | $1,202.26 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,511.89 / $3,162.28
| Professional | | $1,202.26 | $2,511.89 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,344.23 / $2,818.38
| Professional | | $2,041.74 | $2,344.23 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,818.38 / $10,000.00
| Facility | | $1,479.11 | $2,818.38 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,445.44 / $3,630.78
| Professional | | $1,000.00 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,454.71 / $2,951.21
| Professional | | $2,344.23 | $2,454.71 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,630.78 / $3,630.78
| Professional | | $2,238.72 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,187.76 / $5,128.61
| Facility | | $954.99 | $2,187.76 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,148.15 / $2,187.76
| Professional | | $1,000.00 | $1,148.15 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,089.30 / $2,089.30
| Professional | | $1,659.59 | $2,089.30 | $2,089.30 |