- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,258.93 / $1,258.93
| Facility | | $1,230.27 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,230.27 / $1,995.26
| Professional | | $1,096.48 | $1,230.27 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,511.89
| Facility | | $2,398.83 | $2,398.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $2,884.03
| Professional | | $1,380.38 | $1,380.38 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,258.93 / $1,621.81
| Professional | | $1,258.93 | $1,258.93 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,737.80 / $1,737.80
| Facility | | $1,148.15 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,548.82
| Professional | | $1,288.25 | $1,288.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,398.83 / $3,311.31
| Professional | | $1,778.28 | $2,398.83 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,548.82 / $2,344.23
| Professional | | $1,318.26 | $1,548.82 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,737.80 / $2,884.03
| Facility | | $1,023.29 | $1,737.80 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,348.96 / $1,548.82
| Professional | | $1,288.25 | $1,348.96 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,949.84 / $4,897.79
| Facility | | $1,288.25 | $1,949.84 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,949.84 / $4,897.79
| Professional | | $1,288.25 | $1,949.84 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,698.24 / $2,398.83
| Facility | | $870.96 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,202.26 / $1,862.09
| Professional | | $1,122.02 | $1,202.26 | $1,862.09 |