- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $3,388.44 / $8,511.38
| Facility | | $204.17 | $3,388.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $162.18 / $389.05
| Professional | | $75.86 | $162.18 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Professional | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $467.74 / $912.01
| Facility | | $354.81 | $467.74 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $141.25 / $275.42
| Professional | | $87.10 | $141.25 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $234.42 / $380.19
| Professional | | $131.83 | $234.42 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $223.87 / $1,230.27
| Facility | | $104.71 | $223.87 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $269.15 / $1,122.02
| Professional | | $181.97 | $269.15 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $302.00 / $380.19
| Professional | | $165.96 | $302.00 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $323.59
| Professional | | $165.96 | $165.96 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $181.97 / $398.11
| Professional | | $3.02 | $181.97 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $1,047.13 / $3,801.89
| Facility | | $158.49 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $181.97 / $346.74
| Professional | | $102.33 | $181.97 | $346.74 |