- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $2,290.87 / $7,762.47
| Facility | | $338.84 | $2,290.87 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $616.60 / $5,128.61
| Professional | | $194.98 | $616.60 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $5,011.87 / $57,543.99
| Facility | | $3,715.35 | $5,011.87 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $7,585.78 / $57,543.99
| Facility | | $6,456.54 | $7,585.78 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $478.63
| Professional | | $213.80 | $363.08 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $263.03 / $426.58
| Professional | | $194.98 | $263.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $346.74 / $380.19
| Professional | | $229.09 | $346.74 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $295.12 / $407.38
| Professional | | $213.80 | $295.12 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $4,677.35 / $4,897.79
| Facility | | $1,230.27 | $4,677.35 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $218.78
| Professional | | $213.80 | $213.80 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $4,466.84 / $28,183.83
| Facility | | $3,090.30 | $4,466.84 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Professional | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,778.28 / $6,165.95
| Facility | | $363.08 | $1,778.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $251.19 / $512.86
| Professional | | $186.21 | $251.19 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $371.54 / $870.96
| Professional | | $257.04 | $371.54 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $229.09 / $407.38
| Facility | | $208.93 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $229.09 / $407.38
| Professional | | $208.93 | $229.09 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $630.96 / $4,466.84
| Facility | | $162.18 | $630.96 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $245.47 / $436.52
| Professional | | $177.83 | $245.47 | $436.52 |