- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,698.24 / $1,819.70
| Facility | | $1,621.81 | $1,698.24 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,148.15 / $1,862.09
| Professional | | $933.25 | $1,148.15 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $2,454.71
| Facility | | $1,230.27 | $1,230.27 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,511.89 / $3,162.28
| Professional | | $1,230.27 | $2,511.89 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,290.87 / $2,754.23
| Professional | | $2,089.30 | $2,290.87 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,818.38 / $10,232.93
| Facility | | $1,479.11 | $2,818.38 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,479.11 / $3,630.78
| Professional | | $1,023.29 | $1,479.11 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,511.89 / $2,951.21
| Professional | | $2,398.83 | $2,511.89 | $2,951.21 |
- 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
- $2,238.72 / $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
- $977.24 / $2,238.72 / $5,248.07
| Facility | | $977.24 | $2,238.72 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,148.15 / $2,089.30
| Professional | | $1,000.00 | $1,148.15 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,137.96 / $2,137.96
| Professional | | $1,698.24 | $2,137.96 | $2,137.96 |