- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $933.25 / $933.25
| Facility | | $912.01 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $933.25 / $1,479.11
| Professional | | $776.25 | $933.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $1,905.46
| Facility | | $1,778.28 | $1,778.28 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $2,238.72
| Professional | | $1,071.52 | $1,071.52 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $1,230.27
| Professional | | $933.25 | $933.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,380.38 / $1,380.38
| Facility | | $891.25 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,174.90
| Professional | | $1,000.00 | $1,000.00 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,778.28 / $2,511.89
| Professional | | $1,348.96 | $1,778.28 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,174.90 / $1,737.80
| Professional | | $1,023.29 | $1,174.90 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,288.25 / $2,238.72
| Facility | | $758.58 | $1,288.25 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,047.13 / $1,174.90
| Professional | | $954.99 | $1,047.13 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,445.44 / $3,801.89
| Facility | | $1,000.00 | $1,445.44 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,445.44 / $3,801.89
| Professional | | $1,000.00 | $1,445.44 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,318.26 / $1,778.28
| Facility | | $676.08 | $1,318.26 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $870.96 / $1,380.38
| Professional | | $812.83 | $870.96 | $1,380.38 |