- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $2,238.72 / $3,801.89
| Facility | | $288.40 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $295.12 / $616.60
| Professional | | $208.93 | $295.12 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,148.15 / $3,801.89
| Facility | | $56.23 | $1,148.15 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $363.08 / $794.33
| Professional | | $204.17 | $363.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $549.54
| Facility | | $239.88 | $239.88 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $602.56
| Professional | | $239.88 | $407.38 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $426.58 / $758.58
| Professional | | $218.78 | $426.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $245.47 / $3,630.78
| Facility | | $173.78 | $245.47 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $380.19 / $489.78
| Professional | | $323.59 | $380.19 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,511.89 / $7,079.46
| Facility | | $1,148.15 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $346.74 / $741.31
| Professional | | $204.17 | $346.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Professional | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,148.15 / $3,801.89
| Facility | | $56.23 | $1,148.15 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $363.08 / $794.33
| Professional | | $204.17 | $363.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,041.74 / $5,623.41
| Facility | | $776.25 | $2,041.74 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $371.54 / $758.58
| Professional | | $218.78 | $371.54 | $758.58 |