- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,096.48 / $1,698.24
| Professional | | $891.25 | $1,096.48 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $3,630.78
| Facility | | $2,187.76 | $2,187.76 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,041.74 / $2,454.71
| Professional | | $1,995.26 | $2,041.74 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $5,011.87 / $10,715.19
| Facility | | $1,174.90 | $5,011.87 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $3,090.30 / $4,168.69
| Professional | | $870.96 | $3,090.30 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,778.28 / $2,691.53
| Facility | | $1,096.48 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,630.27 / $3,235.94
| Professional | | $1,949.84 | $2,630.27 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $2,137.96 / $9,772.37
| Facility | | $1,096.48 | $2,137.96 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,071.52 / $2,344.23
| Professional | | $870.96 | $1,071.52 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $1,047.13
| Professional | | $54.95 | $70.79 | $1,047.13 |
- 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
- $1,548.82 / $2,454.71 / $4,265.80
| Professional | | $1,548.82 | $2,454.71 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,311.31 / $5,495.41
| Professional | | $2,187.76 | $3,311.31 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $4,365.16 / $11,220.18
| Facility | | $1,174.90 | $4,365.16 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,737.80 / $14,125.38
| Professional | | $870.96 | $1,737.80 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,047.13 / $2,187.76
| Facility | | $676.08 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,071.52 / $1,778.28
| Professional | | $724.44 | $1,071.52 | $1,778.28 |