- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,071.52 / $6,456.54
| Facility | | $436.52 | $1,071.52 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $524.81 / $1,202.26
| Professional | | $436.52 | $524.81 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,897.79 / $7,585.78
| Facility | | $3,311.31 | $4,897.79 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,122.02 / $2,511.89
| Professional | | $562.34 | $1,122.02 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,819.70 / $2,951.21
| Facility | | $1,548.82 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $954.99 / $1,584.89
| Professional | | $512.86 | $954.99 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,202.26 / $3,388.44
| Facility | | $489.78 | $1,202.26 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,380.38 / $1,737.80
| Professional | | $954.99 | $1,380.38 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,202.26 / $5,128.61
| Facility | | $501.19 | $1,202.26 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,000.00 / $3,890.45
| Professional | | $549.54 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,479.11
| Professional | | $32.36 | $33.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $3,890.45 / $4,570.88
| Facility | | $1,071.52 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,412.54 / $2,290.87
| Professional | | $707.95 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,348.96 / $1,949.84
| Professional | | $870.96 | $1,348.96 | $1,949.84 |
- 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
- $512.86 / $891.25 / $4,168.69
| Professional | | $512.86 | $891.25 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $1,096.48
| Professional | | $954.99 | $954.99 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $2,238.72 / $2,630.27
| Professional | | $1,047.13 | $2,238.72 | $2,630.27 |
- 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
- $489.78 / $812.83 / $2,041.74
| Professional | | $489.78 | $812.83 | $2,041.74 |