- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,398.83 / $2,691.53
| Facility | | $1,819.70 | $2,398.83 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,584.89 / $2,398.83
| Professional | | $1,047.13 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $3,467.37
| Facility | | $1,778.28 | $1,778.28 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,715.35 / $4,677.35
| Professional | | $1,778.28 | $3,715.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,235.94 / $3,467.37
| Professional | | $2,630.27 | $3,235.94 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,890.45 / $13,182.57
| Facility | | $2,089.30 | $3,890.45 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,862.09 / $5,128.61
| Professional | | $1,412.54 | $1,862.09 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,467.37 / $3,981.07
| Professional | | $3,388.44 | $3,467.37 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $5,128.61 / $5,128.61
| Professional | | $2,818.38 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $3,090.30 / $6,456.54
| Facility | | $1,202.26 | $3,090.30 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,584.89 / $2,884.03
| Professional | | $1,380.38 | $1,584.89 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,019.95 / $3,019.95
| Professional | | $2,344.23 | $3,019.95 | $3,019.95 |