- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $3,630.78 / $9,549.93
| Facility | | $457.09 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $549.54 / $776.25
| Professional | | $436.52 | $549.54 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $13,182.57 / $15,488.17
| Facility | | $9,772.37 | $13,182.57 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $588.84 / $831.76
| Professional | | $446.68 | $588.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $489.78 / $741.31
| Professional | | $436.52 | $489.78 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $758.58 / $1,445.44
| Professional | | $489.78 | $758.58 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $537.03 / $660.69
| Professional | | $446.68 | $537.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,047.13 / $1,096.48
| Professional | | $831.76 | $1,047.13 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $724.44 / $1,096.48
| Facility | | $457.09 | $724.44 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $912.01 / $10,000.00
| Facility | | $446.68 | $912.01 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $912.01 / $10,000.00
| Professional | | $446.68 | $912.01 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,311.31 / $6,309.57
| Facility | | $1,584.89 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $758.58 / $1,071.52
| Professional | | $436.52 | $758.58 | $1,071.52 |