- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $3,801.89 / $9,772.37
| Facility | | $691.83 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $204.17 / $776.25
| Professional | | $67.61 | $204.17 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $117.49
| Professional | | $53.70 | $53.70 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $3,311.31 / $6,456.54
| Facility | | $1,318.26 | $3,311.31 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $141.25 / $645.65
| Professional | | $61.66 | $141.25 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $616.60 / $1,148.15
| Facility | | $371.54 | $616.60 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $213.80 / $1,148.15
| Professional | | $83.18 | $213.80 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $123.03 / $870.96
| Professional | | $114.82 | $123.03 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $263.03 / $1,000.00
| Facility | | $79.43 | $263.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $4,897.79 / $9,772.37
| Facility | | $1,412.54 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $275.42 / $891.25
| Professional | | $66.07 | $275.42 | $891.25 |