- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $588.84 / $17,782.79
| Facility | | $204.17 | $588.84 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $213.80 / $457.09
| Professional | | $102.33 | $213.80 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,162.28 / $6,456.54
| Facility | | $2,238.72 | $3,162.28 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $309.03 / $489.78
| Professional | | $169.82 | $309.03 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $562.34 / $1,819.70
| Facility | | $181.97 | $562.34 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $251.19 / $562.34
| Professional | | $123.03 | $251.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $281.84 / $1,174.90
| Facility | | $134.90 | $281.84 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $251.19 / $602.56
| Professional | | $125.89 | $251.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $67.61
| Professional | | $32.36 | $33.11 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $398.11 / $457.09
| Facility | | $218.78 | $398.11 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $316.23 / $912.01
| Facility | | $309.03 | $316.23 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $309.03 / $575.44
| Professional | | $144.54 | $309.03 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,235.94 / $6,456.54
| Facility | | $2,187.76 | $3,235.94 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $316.23 / $501.19
| Professional | | $169.82 | $316.23 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $3,715.35 / $6,918.31
| Facility | | $812.83 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $239.88 / $426.58
| Professional | | $128.82 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $204.17 / $363.08
| Professional | | $107.15 | $204.17 | $363.08 |