- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,630.27 / $7,585.78
| Facility | | $1,148.15 | $2,630.27 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,096.48 / $2,238.72
| Professional | | $691.83 | $1,096.48 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,698.24 / $2,344.23
| Facility | | $1,148.15 | $1,698.24 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,148.15 / $1,513.56
| Professional | | $977.24 | $1,148.15 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,398.83 / $3,019.95
| Facility | | $1,174.90 | $2,398.83 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,230.27 / $1,584.89
| Professional | | $616.60 | $1,230.27 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,445.44 / $5,128.61
| Facility | | $1,148.15 | $1,445.44 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,445.44 / $3,548.13
| Professional | | $1,148.15 | $1,445.44 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $2,344.23
| Facility | | $1,148.15 | $1,148.15 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,621.81
| Professional | | $1,148.15 | $1,148.15 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,862.09 / $3,630.78
| Facility | | $1,148.15 | $1,862.09 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,380.38
| Professional | | $1,047.13 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,737.80 / $3,090.30
| Facility | | $1,348.96 | $1,737.80 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,148.15 / $1,513.56
| Professional | | $977.24 | $1,148.15 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,380.38 / $1,380.38
| Facility | | $1,148.15 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $1,288.25
| Professional | | $489.78 | $489.78 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,148.15 / $2,089.30
| Professional | | $524.81 | $1,148.15 | $2,089.30 |