- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $575.44 / $6,760.83
| Facility | | $354.81 | $575.44 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $389.05 / $758.58
| Professional | | $316.23 | $389.05 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $117.49
| Facility | | $114.82 | $114.82 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $524.81 / $1,096.48
| Professional | | $371.54 | $524.81 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $1,513.56
| Facility | | $524.81 | $524.81 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $478.63 / $812.83
| Professional | | $346.74 | $478.63 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $870.96
| Professional | | $575.44 | $575.44 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $446.68 / $724.44
| Facility | | $331.13 | $446.68 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $630.96 / $812.83
| Professional | | $537.03 | $630.96 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $851.14 / $1,995.26
| Facility | | $363.08 | $851.14 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $389.05 / $724.44
| Professional | | $288.40 | $389.05 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $4,897.79 / $28,840.32
| Facility | | $4,897.79 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $2,818.38 / $3,311.31
| Professional | | $2,818.38 | $2,818.38 | $3,311.31 |