- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $17,782.79
| Facility | | $204.17 | $204.17 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $331.13 / $371.54
| Professional | | $204.17 | $331.13 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,882.50 / $18,197.01 / $28,840.32
| Facility | | $12,882.50 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $426.58 / $1,862.09
| Professional | | $263.03 | $426.58 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,047.13 / $1,659.59
| Facility | | $891.25 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $549.54 / $616.60
| Professional | | $371.54 | $549.54 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $346.74 / $776.25
| Facility | | $204.17 | $346.74 | $776.25 |
- 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
- $380.19 / $12,589.25 / $22,908.68
| Facility | | $380.19 | $12,589.25 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $630.96 / $1,584.89
| Professional | | $389.05 | $630.96 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $70.79
| Professional | | $50.12 | $50.12 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,748.98 / $12,882.50 / $27,542.29
| Facility | | $11,748.98 | $12,882.50 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $851.14 / $1,202.26
| Professional | | $575.44 | $851.14 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27,542.29 / $27,542.29 / $41,686.94
| Facility | | $27,542.29 | $27,542.29 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $2,570.40 / $2,570.40
| Professional | | $457.09 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,698.24 / $1,698.24
| Professional | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,344.23 / $2,398.83
| Professional | | $1,621.81 | $2,344.23 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $17,378.01 / $22,908.68
| Facility | | $9,549.93 | $17,378.01 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $630.96 / $1,412.54
| Professional | | $371.54 | $630.96 | $1,412.54 |