- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $2,570.40 / $7,079.46
| Facility | | $416.87 | $2,570.40 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $380.19 / $691.83
| Professional | | $223.87 | $380.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $354.81 / $602.56
| Professional | | $234.42 | $354.81 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $407.38 / $2,511.89
| Professional | | $281.84 | $407.38 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $426.58 / $758.58
| Professional | | $239.88 | $426.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $562.34 / $660.69
| Professional | | $436.52 | $562.34 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $741.31 / $1,096.48
| Professional | | $588.84 | $741.31 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $436.52 / $724.44
| Facility | | $239.88 | $436.52 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Professional | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $309.03 / $2,691.53
| Facility | | $223.87 | $309.03 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $575.44 / $2,691.53
| Professional | | $416.87 | $575.44 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,905.46 / $3,890.45
| Facility | | $954.99 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $389.05 / $758.58
| Professional | | $204.17 | $389.05 | $758.58 |