- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,884.03 / $9,549.93
| Facility | | $524.81 | $2,884.03 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $933.25
| Professional | | $323.59 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $446.68 / $512.86
| Professional | | $398.11 | $446.68 | $512.86 |
- 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 / $331.13 / $588.84
| Professional | | $257.04 | $331.13 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $363.08 / $1,737.80
| Facility | | $316.23 | $363.08 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $398.11
| Professional | | $354.81 | $354.81 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $562.34 / $2,290.87
| Facility | | $323.59 | $562.34 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $912.01
| Professional | | $316.23 | $478.63 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $616.60 / $2,818.38
| Facility | | $512.86 | $616.60 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $812.83
| Professional | | $316.23 | $478.63 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $181.97
| Professional | | $32.36 | $33.11 | $181.97 |
- 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
- $346.74 / $524.81 / $831.76
| Professional | | $346.74 | $524.81 | $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
- $275.42 / $416.87 / $707.95
| Professional | | $275.42 | $416.87 | $707.95 |