- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $3,311.31 / $8,317.64
| Facility | | $467.74 | $3,311.31 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $575.44 / $1,096.48
| Professional | | $354.81 | $575.44 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $309.03 / $489.78
| Professional | | $199.53 | $309.03 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,019.95 / $11,220.18
| Facility | | $776.25 | $3,019.95 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $776.25
| Professional | | $398.11 | $588.84 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,202.26 / $1,412.54
| Facility | | $436.52 | $1,202.26 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $588.84 / $1,023.29
| Professional | | $363.08 | $588.84 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $9,120.11 / $16,982.44
| Facility | | $4,466.84 | $9,120.11 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $537.03 / $794.33
| Professional | | $478.63 | $537.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $478.63 / $954.99
| Professional | | $32.36 | $478.63 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,570.40 / $5,011.87
| Facility | | $588.84 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $562.34 / $1,023.29
| Professional | | $346.74 | $562.34 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $724.44
| Professional | | $316.23 | $489.78 | $724.44 |