- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $2,630.27 / $8,317.64
| Facility | | $363.08 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $588.84 / $977.24
| Professional | | $302.00 | $588.84 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- 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
- $371.54 / $489.78 / $3,019.95
| Professional | | $371.54 | $489.78 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $630.96 / $1,122.02
| Professional | | $331.13 | $630.96 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $933.25 / $1,122.02
| Professional | | $724.44 | $933.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $851.14 / $1,621.81
| Professional | | $691.83 | $851.14 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $630.96 / $1,096.48
| Facility | | $331.13 | $630.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $7,413.10
| Facility | | $302.00 | $416.87 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $776.25 / $7,413.10
| Professional | | $562.34 | $776.25 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $6,025.60 / $12,882.50
| Facility | | $3,548.13 | $6,025.60 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $537.03 / $1,071.52
| Professional | | $281.84 | $537.03 | $1,071.52 |