- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $707.95 / $3,090.30
| Facility | | $281.84 | $707.95 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $467.74 / $1,071.52
| Professional | | $281.84 | $467.74 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,570.88 / $7,079.46
| Facility | | $2,344.23 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $954.99 / $2,089.30
| Professional | | $501.19 | $954.99 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,659.59 / $2,691.53
| Facility | | $1,445.44 | $1,659.59 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $870.96 / $1,445.44
| Professional | | $398.11 | $870.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $933.25 / $3,981.07
| Facility | | $331.13 | $933.25 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $977.24 / $1,584.89
| Professional | | $630.96 | $977.24 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $933.25 / $5,128.61
| Facility | | $346.74 | $933.25 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $954.99 / $2,570.40
| Professional | | $501.19 | $954.99 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $977.24
| Professional | | $32.36 | $33.11 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,890.45 / $4,570.88
| Facility | | $758.58 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,148.15 / $1,548.82
| Professional | | $588.84 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,148.15 / $1,995.26
| Professional | | $676.08 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $5,623.41 / $5,623.41
| Facility | | $3,801.89 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $831.76 / $3,890.45
| Professional | | $398.11 | $831.76 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $1,023.29
| Professional | | $630.96 | $630.96 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,445.44 / $2,290.87
| Professional | | $794.33 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,548.13 / $6,918.31
| Facility | | $2,884.03 | $3,548.13 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $676.08 / $1,659.59
| Professional | | $354.81 | $676.08 | $1,659.59 |