- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $2,818.38 / $5,128.61
| Facility | | $371.54 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $371.54 / $645.65
| Professional | | $239.88 | $371.54 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,511.89 / $6,165.95
| Facility | | $56.23 | $2,511.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $1,096.48
| Professional | | $251.19 | $446.68 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $630.96
| Facility | | $275.42 | $275.42 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $467.74 / $812.83
| Professional | | $275.42 | $467.74 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $512.86 / $933.25
| Professional | | $245.47 | $512.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $288.40 / $3,630.78
| Facility | | $204.17 | $288.40 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $501.19 / $660.69
| Professional | | $426.58 | $501.19 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,265.80 / $9,772.37
| Facility | | $2,041.74 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $446.68 / $977.24
| Professional | | $239.88 | $446.68 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,511.89 / $6,165.95
| Facility | | $56.23 | $2,511.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $1,096.48
| Professional | | $251.19 | $446.68 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,890.45 / $8,709.64
| Facility | | $1,698.24 | $3,890.45 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $457.09 / $1,000.00
| Professional | | $251.19 | $457.09 | $1,000.00 |