- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $3,311.31 / $8,511.38
| Facility | | $380.19 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $162.18 / $363.08
| Professional | | $79.43 | $162.18 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $91.20 / $151.36
| Professional | | $67.61 | $91.20 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,698.24 / $11,220.18
| Facility | | $331.13 | $1,698.24 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $141.25 / $181.97
| Professional | | $75.86 | $141.25 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $489.78 / $794.33
| Facility | | $141.25 | $489.78 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $158.49 / $316.23
| Professional | | $85.11 | $158.49 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $5,128.61 / $10,232.93
| Facility | | $2,630.27 | $5,128.61 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $158.49 / $288.40
| Professional | | $81.28 | $158.49 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $61.66 / $208.93
| Professional | | $32.36 | $61.66 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $3,090.30 / $6,760.83
| Facility | | $676.08 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $134.90 / $257.04
| Professional | | $70.79 | $134.90 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $177.83
| Professional | | $61.66 | $131.83 | $177.83 |