- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $630.96 / $912.01
| Facility | | $269.15 | $630.96 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $426.58 / $645.65
| Professional | | $309.03 | $426.58 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $1,621.81
| Facility | | $812.83 | $812.83 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $1,380.38
| Professional | | $478.63 | $478.63 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $660.69 / $660.69
| Facility | | $616.60 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $53,703.18
| Facility | | $489.78 | $489.78 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $912.01
| Professional | | $363.08 | $363.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,318.26 / $3,090.30
| Facility | | $812.83 | $1,318.26 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $812.83 / $1,548.82
| Professional | | $501.19 | $812.83 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $524.81
| Facility | | $501.19 | $501.19 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $501.19 / $501.19
| Professional | | $478.63 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $50,118.72 / $75,857.76
| Facility | | $1,071.52 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $776.25 / $776.25
| Professional | | $524.81 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $457.09 / $2,238.72
| Facility | | $323.59 | $457.09 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $524.81 / $1,348.96
| Professional | | $295.12 | $524.81 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $489.78 / $524.81
| Facility | | $478.63 | $489.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $501.19 / $501.19
| Professional | | $478.63 | $501.19 | $501.19 |