- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $3,801.89 / $9,120.11
| Facility | | $354.81 | $3,801.89 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $380.19 / $741.31
| Professional | | $223.87 | $380.19 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $9,549.93
| Facility | | $2,630.27 | $4,786.30 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $316.23 / $724.44
| Professional | | $269.15 | $316.23 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,995.26 / $8,912.51
| Facility | | $316.23 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $549.54
| Professional | | $316.23 | $316.23 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,862.09 / $50,118.72
| Facility | | $398.11 | $1,862.09 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $467.74 / $1,096.48
| Professional | | $251.19 | $467.74 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $302.00 / $812.83
| Facility | | $245.47 | $302.00 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $575.44 / $870.96
| Professional | | $446.68 | $575.44 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Facility | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $512.86 / $831.76
| Professional | | $275.42 | $512.86 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $50,118.72 / $75,857.76
| Facility | | $234.42 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $478.63 / $1,047.13
| Professional | | $398.11 | $478.63 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,981.07 / $8,912.51
| Facility | | $1,698.24 | $3,981.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $575.44 / $1,513.56
| Professional | | $245.47 | $575.44 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $912.01
| Facility | | $190.55 | $281.84 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $478.63 / $831.76
| Professional | | $281.84 | $478.63 | $831.76 |