- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $2,630.27
| Facility | | $724.44 | $724.44 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $645.65 / $912.01
| Professional | | $457.09 | $645.65 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $977.24 / $2,344.23
| Professional | | $562.34 | $977.24 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,238.72 / $3,548.13
| Facility | | $1,905.46 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,819.70 / $2,238.72
| Professional | | $870.96 | $1,819.70 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $724.44 / $1,096.48
| Facility | | $398.11 | $724.44 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,479.11 / $1,905.46
| Professional | | $1,288.25 | $1,479.11 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $724.44 / $1,412.54
| Facility | | $398.11 | $724.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,023.29 / $3,981.07
| Professional | | $436.52 | $1,023.29 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $630.96
| Professional | | $32.36 | $33.11 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $891.25 / $1,174.90
| Facility | | $660.69 | $891.25 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $891.25 / $1,737.80
| Professional | | $524.81 | $891.25 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,698.24 / $2,511.89
| Professional | | $851.14 | $1,698.24 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,981.07 / $3,981.07
| Facility | | $1,659.59 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,951.21 / $3,981.07
| Professional | | $776.25 | $2,951.21 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Professional | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,862.09 / $3,630.78
| Professional | | $1,202.26 | $1,862.09 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $3,019.95
| Facility | | $2,290.87 | $2,290.87 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $933.25 / $1,949.84
| Professional | | $446.68 | $933.25 | $1,949.84 |