- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,951.21 / $9,549.93
| Facility | | $1,348.96 | $2,951.21 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,096.48 / $2,238.72
| Professional | | $758.58 | $1,096.48 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,995.26 / $2,691.53
| Facility | | $1,348.96 | $1,995.26 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,288.25 / $1,778.28
| Professional | | $1,148.15 | $1,288.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $3,019.95 / $3,548.13
| Facility | | $1,412.54 | $3,019.95 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,513.56 / $1,949.84
| Professional | | $676.08 | $1,513.56 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,698.24 / $4,168.69
| Facility | | $1,348.96 | $1,698.24 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,698.24 / $3,890.45
| Professional | | $1,348.96 | $1,698.24 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $1,071.52 / $1,445.44
| Professional | | $75.86 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $2,691.53
| Facility | | $1,348.96 | $1,348.96 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $2,041.74
| Professional | | $1,348.96 | $1,348.96 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,137.96 / $4,168.69
| Facility | | $1,348.96 | $2,137.96 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,659.59
| Professional | | $1,202.26 | $1,202.26 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,041.74 / $3,548.13
| Facility | | $1,548.82 | $2,041.74 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,230.27 / $1,778.28
| Professional | | $1,096.48 | $1,230.27 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,621.81 / $1,621.81
| Facility | | $1,202.26 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $1,513.56
| Professional | | $562.34 | $562.34 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $691.83 / $2,454.71
| Professional | | $602.56 | $691.83 | $2,454.71 |