- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $3,630.78 / $10,471.29
| Facility | | $660.69 | $3,630.78 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $870.96 / $1,445.44
| Professional | | $630.96 | $870.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $691.83
| Professional | | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $6,606.93 / $13,182.57
| Facility | | $3,801.89 | $6,606.93 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $912.01 / $1,288.25
| Professional | | $776.25 | $912.01 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $691.83 / $891.25
| Facility | | $562.34 | $691.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $758.58 / $912.01
| Professional | | $501.19 | $758.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $1,023.29 / $1,023.29
| Facility | | $34.67 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | 54 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,479.11 / $4,677.35
| Professional | | $758.58 | $1,479.11 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $645.65
| Professional | | $32.36 | $33.11 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $6,025.60 / $10,471.29
| Facility | | $851.14 | $6,025.60 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,148.15 / $1,905.46
| Professional | | $870.96 | $1,148.15 | $1,905.46 |