- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $851.14 / $1,230.27
| Professional | | $724.44 | $851.14 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $2,818.38
| Facility | | $1,737.80 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,905.46
| Professional | | $1,584.89 | $1,584.89 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $3,981.07 / $8,511.38
| Facility | | $933.25 | $3,981.07 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,454.71 / $3,235.94
| Professional | | $691.83 | $2,454.71 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,380.38 / $2,137.96
| Facility | | $831.76 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,659.59 / $2,041.74
| Professional | | $954.99 | $1,659.59 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,698.24 / $7,943.28
| Facility | | $851.14 | $1,698.24 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $891.25 / $1,862.09
| Professional | | $758.58 | $891.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $2,041.74
| Professional | | $54.95 | $70.79 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,949.84 / $3,388.44
| Professional | | $1,230.27 | $1,949.84 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,570.40 / $4,786.30
| Professional | | $1,737.80 | $2,570.40 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $3,388.44 / $7,943.28
| Facility | | $933.25 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,380.38 / $8,511.38
| Professional | | $691.83 | $1,380.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $870.96 / $1,737.80
| Facility | | $512.86 | $870.96 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $831.76 / $1,412.54
| Professional | | $588.84 | $831.76 | $1,412.54 |