- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $588.84 / $831.76
| Facility | | $269.15 | $588.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $398.11 / $660.69
| Professional | | $295.12 | $398.11 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $1,479.11
| Facility | | $741.31 | $741.31 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $1,258.93
| Professional | | $446.68 | $446.68 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $616.60 / $616.60
| Facility | | $562.34 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $53,703.18
| Facility | | $457.09 | $457.09 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $912.01
| Professional | | $331.13 | $331.13 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,230.27 / $2,884.03
| Facility | | $741.31 | $1,230.27 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $741.31 / $1,412.54
| Professional | | $467.74 | $741.31 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $478.63
| Facility | | $457.09 | $457.09 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $457.09 / $467.74
| Professional | | $436.52 | $457.09 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $50,118.72 / $75,857.76
| Facility | | $977.24 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $707.95 / $707.95
| Professional | | $489.78 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $549.54 / $2,089.30
| Facility | | $302.00 | $549.54 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $489.78 / $1,230.27
| Professional | | $263.03 | $489.78 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $457.09 / $478.63
| Facility | | $436.52 | $457.09 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $457.09 / $467.74
| Professional | | $436.52 | $457.09 | $467.74 |