- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $7,079.46 / $12,589.25
| Facility | | $707.95 | $7,079.46 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $407.38 / $1,047.13
| Professional | | $199.53 | $407.38 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $218.78 / $363.08
| Professional | | $186.21 | $218.78 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $6,760.83 / $13,182.57
| Facility | | $5,248.07 | $6,760.83 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $371.54 / $707.95
| Professional | | $223.87 | $371.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $602.56 / $1,023.29
| Professional | | $302.00 | $602.56 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $588.84 / $5,754.40
| Facility | | $275.42 | $588.84 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $602.56 / $3,311.31
| Professional | | $436.52 | $602.56 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $724.44 / $912.01
| Professional | | $380.19 | $724.44 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $776.25
| Professional | | $436.52 | $436.52 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $467.74 / $1,000.00
| Professional | | $3.02 | $467.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $5,370.32 / $7,585.78
| Facility | | $4,365.16 | $5,370.32 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $446.68 / $831.76
| Professional | | $269.15 | $446.68 | $831.76 |