- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $2,884.03 / $10,715.19
| Facility | | $251.19 | $2,884.03 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $602.56
| Professional | | $154.88 | $257.04 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $213.80
| Professional | | $67.61 | $67.61 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,238.72 / $3,981.07
| Facility | | $707.95 | $2,238.72 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $234.42 / $389.05
| Professional | | $158.49 | $234.42 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $288.40 / $501.19
| Professional | | $177.83 | $288.40 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $21,379.62
| Facility | | $1,071.52 | $1,071.52 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $275.42 / $489.78
| Professional | | $165.96 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $154.88
| Professional | | $32.36 | $33.11 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $436.52
| Facility | | $100.00 | $100.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $263.03 / $467.74
| Professional | | $158.49 | $263.03 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,698.24 / $4,073.80
| Facility | | $537.03 | $1,698.24 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $234.42 / $389.05
| Professional | | $154.88 | $234.42 | $389.05 |