- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $3,715.35 / $10,715.19
| Facility | | $602.56 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $407.38 / $1,202.26
| Professional | | $346.74 | $407.38 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $3,019.95 / $5,888.44
| Facility | | $954.99 | $3,019.95 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $346.74 / $562.34
| Professional | | $257.04 | $346.74 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $398.11 / $1,737.80
| Facility | | $354.81 | $398.11 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $446.68
| Professional | | $398.11 | $398.11 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $616.60 / $2,290.87
| Facility | | $389.05 | $616.60 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $812.83
| Professional | | $316.23 | $478.63 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $630.96 / $2,818.38
| Facility | | $512.86 | $630.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $758.58
| Professional | | $316.23 | $478.63 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $48.98
| Professional | | $32.36 | $33.11 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $3,388.44
| Facility | | $100.00 | $100.00 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $446.68 / $831.76
| Professional | | $380.19 | $446.68 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $4,168.69 / $7,413.10
| Facility | | $870.96 | $4,168.69 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $398.11 / $660.69
| Professional | | $288.40 | $398.11 | $660.69 |