- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $3,890.45 / $8,912.51
| Facility | | $645.65 | $3,890.45 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $295.12 / $537.03
| Professional | | $204.17 | $295.12 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $251.19 / $281.84
| Professional | | $141.25 | $251.19 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $2,041.74 / $11,220.18
| Facility | | $660.69 | $2,041.74 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $281.84 / $371.54
| Professional | | $213.80 | $281.84 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $707.95 / $831.76
| Facility | | $398.11 | $707.95 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $309.03 / $524.81
| Professional | | $204.17 | $309.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $5,248.07 / $10,471.29
| Facility | | $2,818.38 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $263.03 / $380.19
| Professional | | $234.42 | $263.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $263.03 / $489.78
| Professional | | $32.36 | $263.03 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $3,311.31 / $6,918.31
| Facility | | $1,047.13 | $3,311.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $275.42 / $512.86
| Professional | | $186.21 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $257.04 / $354.81
| Professional | | $181.97 | $257.04 | $354.81 |