- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $3,090.30 / $6,760.83
| Facility | | $275.42 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $288.40 / $588.84
| Professional | | $154.88 | $288.40 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $389.05 / $912.01
| Professional | | $173.78 | $389.05 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $416.87 / $724.44
| Professional | | $154.88 | $416.87 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $416.87 / $5,888.44
| Facility | | $194.98 | $416.87 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $512.86 / $2,290.87
| Professional | | $288.40 | $512.86 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $436.52 / $758.58
| Professional | | $363.08 | $436.52 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $501.19 / $812.83
| Professional | | $309.03 | $501.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $549.54 / $851.14
| Professional | | $5.01 | $549.54 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $5,128.61 / $8,709.64
| Facility | | $2,570.40 | $5,128.61 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $302.00 / $616.60
| Professional | | $169.82 | $302.00 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $389.05 / $691.83
| Professional | | $316.23 | $389.05 | $691.83 |