- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,548.82 / $2,511.89
| Facility | | $630.96 | $1,548.82 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $489.78 / $1,174.90
| Professional | | $398.11 | $489.78 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,023.29 / $9,332.54
| Facility | | $446.68 | $1,023.29 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,884.03 / $5,011.87
| Facility | | $2,187.76 | $2,884.03 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $912.01 / $1,737.80
| Facility | | $426.58 | $912.01 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $645.65 / $1,348.96
| Professional | | $281.84 | $645.65 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $537.03 / $870.96
| Professional | | $281.84 | $537.03 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $912.01 / $1,318.26
| Professional | | $602.56 | $912.01 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,202.26 / $1,659.59
| Facility | | $467.74 | $1,202.26 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $389.05
| Professional | | $354.81 | $354.81 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $870.96 / $2,041.74
| Facility | | $467.74 | $870.96 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,479.11 / $2,041.74
| Facility | | $489.78 | $1,479.11 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $489.78 / $912.01
| Professional | | $398.11 | $489.78 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $660.69 / $1,023.29
| Facility | | $588.84 | $660.69 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $660.69 / $812.83
| Professional | | $588.84 | $660.69 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $602.56 / $724.44
| Facility | | $251.19 | $602.56 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $354.81 / $741.31
| Professional | | $81.28 | $354.81 | $741.31 |