- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $346.74 / $6,456.54
| Facility | | $158.49 | $346.74 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $218.78 / $489.78
| Professional | | $154.88 | $218.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $426.58 / $1,071.52
| Professional | | $223.87 | $426.58 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $724.44 / $1,202.26
| Facility | | $616.60 | $724.44 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $524.81 / $1,096.48
| Professional | | $239.88 | $524.81 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $295.12 / $4,897.79
| Facility | | $158.49 | $295.12 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $446.68 / $645.65
| Professional | | $309.03 | $446.68 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $323.59 / $10,471.29
| Facility | | $162.18 | $323.59 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $446.68 / $1,737.80
| Professional | | $213.80 | $446.68 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $199.53
| Professional | | $32.36 | $33.11 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $8,511.38 / $9,120.11
| Facility | | $309.03 | $8,511.38 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $467.74 / $724.44
| Professional | | $288.40 | $467.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $524.81 / $831.76
| Professional | | $309.03 | $524.81 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $6,025.60 / $8,912.51
| Facility | | $3,235.94 | $6,025.60 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,023.29 / $1,698.24
| Professional | | $302.00 | $1,023.29 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $724.44
| Professional | | $524.81 | $524.81 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,071.52 / $1,479.11
| Professional | | $316.23 | $1,071.52 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $10,000.00 / $12,022.64
| Facility | | $6,309.57 | $10,000.00 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $316.23 / $891.25
| Professional | | $95.50 | $316.23 | $891.25 |