- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $891.25 / $891.25
| Professional | | $478.63 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,511.89 / $2,511.89
| Facility | | $1,380.38 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,380.38 / $1,737.80
| Professional | | $1,023.29 | $1,380.38 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $812.83 / $5,623.41
| Facility | | $794.33 | $812.83 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,698.24 / $2,691.53
| Professional | | $676.08 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $891.25 / $1,479.11
| Facility | | $109.65 | $891.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $912.01 / $7,079.46
| Facility | | $97.72 | $912.01 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $776.25 / $1,288.25
| Professional | | $562.34 | $776.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $58.88 / $1,122.02
| Professional | | $50.12 | $58.88 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $309.03 / $346.74
| Professional | | $154.88 | $309.03 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $2,511.89 / $7,413.10
| Facility | | $64.57 | $2,511.89 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $794.33 / $812.83
| Professional | | $107.15 | $794.33 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $398.11 / $1,047.13
| Facility | | $52.48 | $398.11 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $676.08 / $1,380.38
| Professional | | $512.86 | $676.08 | $1,380.38 |