- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,659.59 / $1,905.46
| Facility | | $1,548.82 | $1,659.59 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,995.26 / $2,818.38
| Professional | | $1,548.82 | $1,995.26 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,691.53 / $3,311.31
| Professional | | $2,344.23 | $2,691.53 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $3,388.44 / $3,630.78
| Professional | | $2,691.53 | $3,388.44 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $6,165.95
| Facility | | $2,137.96 | $2,137.96 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $2,137.96
| Professional | | $1,584.89 | $1,584.89 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,258.93 / $1,778.28
| Facility | | $1,258.93 | $1,258.93 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,187.76 / $3,630.78
| Professional | | $1,584.89 | $2,187.76 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,905.46 / $2,398.83
| Professional | | $1,230.27 | $1,905.46 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,570.40 / $4,677.35
| Facility | | $1,548.82 | $2,570.40 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,778.28 / $2,570.40
| Professional | | $1,548.82 | $1,778.28 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $3,630.78
| Professional | | $1,905.46 | $1,905.46 | $3,630.78 |