- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $776.25 / $3,890.45
| Facility | | $177.83 | $776.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $316.23 / $776.25
| Professional | | $181.97 | $316.23 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,090.30 / $5,754.40
| Facility | | $2,238.72 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $588.84 / $1,258.93
| Professional | | $302.00 | $588.84 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $977.24 / $1,548.82
| Facility | | $831.76 | $977.24 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $467.74 / $831.76
| Professional | | $223.87 | $467.74 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $588.84 / $3,981.07
| Facility | | $208.93 | $588.84 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $575.44 / $912.01
| Professional | | $389.05 | $575.44 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $588.84 / $3,981.07
| Facility | | $208.93 | $588.84 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $549.54 / $1,584.89
| Professional | | $288.40 | $549.54 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $616.60
| Professional | | $32.36 | $33.11 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $2,951.21 / $3,235.94
| Facility | | $426.58 | $2,951.21 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $691.83 / $933.25
| Professional | | $338.84 | $691.83 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $602.56 / $1,023.29
| Professional | | $354.81 | $602.56 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,187.76 / $2,187.76
| Facility | | $1,445.44 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $426.58 / $2,238.72
| Professional | | $218.78 | $426.58 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $575.44
| Professional | | $389.05 | $389.05 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $912.01 / $1,348.96
| Professional | | $389.05 | $912.01 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,754.23 / $5,011.87
| Facility | | $1,949.84 | $2,754.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $398.11 / $1,258.93
| Professional | | $91.20 | $398.11 | $1,258.93 |