- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $676.08 / $933.25
| Facility | | $537.03 | $676.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,023.29 / $2,089.30
| Professional | | $630.96 | $1,023.29 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,000.00 / $1,445.44
| Professional | | $758.58 | $1,000.00 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $6,760.83 / $12,302.69
| Facility | | $1,096.48 | $6,760.83 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $891.25 / $1,174.90
| Professional | | $691.83 | $891.25 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,023.29 / $1,819.70
| Professional | | $691.83 | $1,023.29 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,884.03 / $6,760.83
| Facility | | $1,548.82 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $812.83 / $1,047.13
| Professional | | $776.25 | $812.83 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $5,248.07 / $11,220.18
| Facility | | $724.44 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $912.01 / $1,659.59
| Professional | | $575.44 | $912.01 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $851.14 / $1,174.90
| Professional | | $660.69 | $851.14 | $1,174.90 |