- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $3,162.28 / $8,511.38
| Facility | | $407.38 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $776.25 / $3,090.30
| Professional | | $199.53 | $776.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Professional | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,128.61 / $10,000.00
| Facility | | $3,890.45 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $630.96 / $1,513.56
| Professional | | $229.09 | $630.96 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $724.44 / $2,238.72
| Professional | | $416.87 | $724.44 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $1,230.27 / $6,456.54
| Facility | | $275.42 | $1,230.27 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,548.82 / $8,317.64
| Professional | | $977.24 | $1,548.82 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,584.89 / $2,137.96
| Professional | | $457.09 | $1,584.89 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $1,621.81
| Professional | | $436.52 | $436.52 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $501.19 / $2,187.76
| Professional | | $3.02 | $501.19 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,370.32 / $6,760.83
| Facility | | $3,630.78 | $5,370.32 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $912.01 / $1,862.09
| Professional | | $275.42 | $912.01 | $1,862.09 |