- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $5,754.40 / $10,964.78
| Facility | | $537.03 | $5,754.40 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $331.13 / $1,023.29
| Professional | | $263.03 | $331.13 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $3,388.44 / $10,964.78
| Facility | | $954.99 | $3,388.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $380.19 / $588.84
| Professional | | $281.84 | $380.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $295.12 / $3,981.07
| Facility | | $263.03 | $295.12 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $331.13
| Professional | | $295.12 | $295.12 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $478.63 / $5,370.32
| Facility | | $407.38 | $478.63 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $389.05 / $660.69
| Professional | | $257.04 | $389.05 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $707.95 / $6,456.54
| Facility | | $478.63 | $707.95 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $660.69
| Professional | | $245.47 | $380.19 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $56.23
| Professional | | $32.36 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $7,943.28
| Facility | | $100.00 | $100.00 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $309.03 / $588.84
| Professional | | $263.03 | $309.03 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $7,943.28 / $15,488.17
| Facility | | $1,288.25 | $7,943.28 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $338.84 / $524.81
| Professional | | $234.42 | $338.84 | $524.81 |