- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $3,467.37 / $10,715.19
| Facility | | $549.54 | $3,467.37 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $933.25
| Professional | | $338.84 | $501.19 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Professional | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,548.13 / $15,135.61
| Facility | | $1,698.24 | $3,548.13 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $309.03 / $512.86
| Professional | | $239.88 | $309.03 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $398.11
| Facility | | $338.84 | $338.84 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $575.44 / $21,379.62
| Facility | | $416.87 | $575.44 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $912.01
| Professional | | $354.81 | $562.34 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $562.34 / $870.96
| Professional | | $346.74 | $562.34 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $69.18
| Professional | | $32.36 | $33.11 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $3,981.07
| Facility | | $100.00 | $100.00 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $537.03 / $812.83
| Professional | | $338.84 | $537.03 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,466.84 / $7,762.47
| Facility | | $2,454.71 | $4,466.84 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $489.78 / $812.83
| Professional | | $309.03 | $489.78 | $812.83 |