- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,380.38 / $2,290.87
| Professional | | $1,174.90 | $1,380.38 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $4,677.35
| Facility | | $2,818.38 | $2,818.38 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,630.27 / $3,162.28
| Professional | | $2,344.23 | $2,630.27 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $6,456.54 / $13,803.84
| Facility | | $1,778.28 | $6,456.54 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $3,981.07 / $5,370.32
| Professional | | $1,318.26 | $3,981.07 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,290.87 / $3,467.37
| Facility | | $1,380.38 | $2,290.87 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,691.53 / $3,388.44
| Professional | | $1,584.89 | $2,691.53 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,754.23 / $12,882.50
| Facility | | $1,380.38 | $2,754.23 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,778.28 / $3,090.30
| Professional | | $1,258.93 | $1,778.28 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $169.82
| Professional | | $54.95 | $70.79 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,162.28 / $5,495.41
| Professional | | $1,995.26 | $3,162.28 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,265.80 / $7,762.47
| Professional | | $2,818.38 | $4,265.80 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $5,623.41 / $12,882.50
| Facility | | $1,778.28 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,630.27 / $13,803.84
| Professional | | $1,318.26 | $2,630.27 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,862.09 / $2,818.38
| Facility | | $1,479.11 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,380.38 / $2,290.87
| Professional | | $1,071.52 | $1,380.38 | $2,290.87 |