- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $977.24 / $977.24
| Facility | | $954.99 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $977.24 / $1,698.24
| Professional | | $812.83 | $977.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $1,995.26
| Facility | | $1,862.09 | $1,862.09 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $2,344.23
| Professional | | $1,122.02 | $1,122.02 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $1,288.25
| Professional | | $977.24 | $977.24 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,584.89 / $1,584.89
| Facility | | $1,023.29 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,230.27
| Professional | | $1,148.15 | $1,148.15 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,862.09 / $2,630.27
| Professional | | $1,380.38 | $1,862.09 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,230.27 / $1,819.70
| Professional | | $1,096.48 | $1,230.27 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,348.96 / $2,344.23
| Facility | | $794.33 | $1,348.96 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,096.48 / $1,202.26
| Professional | | $1,000.00 | $1,096.48 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,513.56 / $3,981.07
| Facility | | $1,047.13 | $1,513.56 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,513.56 / $3,981.07
| Professional | | $1,047.13 | $1,513.56 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,380.38 / $1,862.09
| Facility | | $707.95 | $1,380.38 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $933.25 / $1,445.44
| Professional | | $870.96 | $933.25 | $1,445.44 |