- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $2,951.21 / $7,762.47
| Facility | | $208.93 | $2,951.21 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $338.84 / $776.25
| Professional | | $138.04 | $338.84 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $354.81
| Professional | | $323.59 | $323.59 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $10,232.93
| Facility | | $2,630.27 | $4,786.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $363.08 / $954.99
| Professional | | $288.40 | $363.08 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,258.93 / $4,073.80
| Facility | | $204.17 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $537.03
| Professional | | $204.17 | $204.17 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $1,318.26 / $50,118.72
| Facility | | $245.47 | $1,318.26 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $436.52 / $1,258.93
| Professional | | $165.96 | $436.52 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $223.87 / $537.03
| Facility | | $151.36 | $223.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $851.14
| Professional | | $407.38 | $602.56 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Facility | | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $457.09 / $741.31
| Professional | | $323.59 | $457.09 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $1,023.29
| Professional | | $154.88 | $154.88 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $50,118.72 / $75,857.76
| Facility | | $162.18 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $489.78 / $794.33
| Professional | | $398.11 | $489.78 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,467.37 / $7,244.36
| Facility | | $1,862.09 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $416.87 / $1,071.52
| Professional | | $147.91 | $416.87 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $616.60
| Facility | | $117.49 | $173.78 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $389.05 / $724.44
| Professional | | $288.40 | $389.05 | $724.44 |