- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,071.52 / $3,548.13
| Facility | | $758.58 | $1,071.52 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $831.76 / $1,995.26
| Professional | | $645.65 | $831.76 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $758.58 / $1,949.84
| Professional | | $588.84 | $758.58 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $645.65
| Facility | | $426.58 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $645.65 / $1,071.52
| Professional | | $426.58 | $645.65 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,096.48 / $2,344.23
| Facility | | $812.83 | $1,096.48 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,148.15 / $2,818.38
| Professional | | $691.83 | $1,148.15 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $446.68 / $1,348.96
| Facility | | $338.84 | $446.68 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,122.02 / $1,698.24
| Professional | | $794.33 | $1,122.02 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $794.33 / $1,584.89
| Professional | | $512.86 | $794.33 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $933.25 / $53,703.18
| Facility | | $588.84 | $933.25 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,047.13 / $1,737.80
| Professional | | $870.96 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,621.81 / $3,090.30
| Facility | | $1,096.48 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $954.99 / $2,238.72
| Professional | | $562.34 | $954.99 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $512.86 / $1,230.27
| Facility | | $436.52 | $512.86 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $831.76 / $1,995.26
| Professional | | $457.09 | $831.76 | $1,995.26 |