- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $724.44 / $1,862.09
| Facility | | $602.56 | $724.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $724.44 / $1,318.26
| Professional | | $602.56 | $724.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,513.56 / $1,584.89
| Facility | | $1,513.56 | $1,513.56 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $1,659.59
| Professional | | $794.33 | $794.33 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $1,023.29
| Professional | | $776.25 | $776.25 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,047.13 / $1,047.13
| Facility | | $630.96 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $912.01
| Professional | | $758.58 | $758.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,513.56 / $2,089.30
| Professional | | $1,122.02 | $1,513.56 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $977.24 / $1,479.11
| Professional | | $758.58 | $977.24 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $977.24 / $1,698.24
| Facility | | $602.56 | $977.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $912.01 / $1,862.09
| Professional | | $812.83 | $912.01 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,258.93 / $3,235.94
| Facility | | $812.83 | $1,258.93 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,230.27 / $3,235.94
| Professional | | $812.83 | $1,230.27 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $660.69 / $1,819.70
| Facility | | $457.09 | $660.69 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $724.44 / $1,202.26
| Professional | | $676.08 | $724.44 | $1,202.26 |