- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $2,290.87 / $7,943.28
| Facility | | $93.33 | $2,290.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $104.71 / $257.04
| Professional | | $39.81 | $104.71 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $123.03 / $223.87
| Professional | | $93.33 | $123.03 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $4,073.80 / $12,302.69
| Facility | | $125.89 | $4,073.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $79.43 / $131.83
| Professional | | $39.81 | $79.43 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $69.18 / $512.86
| Facility | | $50.12 | $69.18 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $91.20 / $199.53
| Professional | | $40.74 | $91.20 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,995.26 / $3,388.44
| Facility | | $1,380.38 | $1,995.26 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $77.62 / $144.54
| Professional | | $37.15 | $77.62 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $34.67 / $144.54
| Professional | | $32.36 | $34.67 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,288.25 / $3,630.78
| Facility | | $162.18 | $1,288.25 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $69.18 / $144.54
| Professional | | $32.36 | $69.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $87.10 / $131.83
| Professional | | $31.62 | $87.10 | $131.83 |