- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $263.03 / $1,905.46
| Facility | | $34.67 | $263.03 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $263.03 / $562.34
| Professional | | $34.67 | $263.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,584.89 / $1,584.89
| Facility | | $1,202.26 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $398.11 / $1,202.26
| Professional | | $67.61 | $398.11 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $954.99 / $1,513.56
| Facility | | $812.83 | $954.99 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $275.42 / $891.25
| Professional | | $67.61 | $275.42 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $2,398.83 / $4,265.80
| Facility | | $41.69 | $2,398.83 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $851.14
| Professional | | $89.13 | $141.25 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $912.01 / $1,778.28
| Facility | | $45.71 | $912.01 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $707.95 / $1,621.81
| Professional | | $398.11 | $707.95 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $128.82
| Professional | | $32.36 | $33.11 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $933.25 / $2,344.23
| Facility | | $831.76 | $933.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $426.58 / $1,288.25
| Professional | | $114.82 | $426.58 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $309.03 / $1,000.00
| Professional | | $70.79 | $309.03 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $891.25
| Facility | | $107.15 | $107.15 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $630.96 / $2,041.74
| Professional | | $77.62 | $630.96 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $602.56
| Professional | | $79.43 | $79.43 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $691.83 / $1,288.25
| Professional | | $89.13 | $691.83 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,584.89 / $2,187.76
| Facility | | $1,023.29 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $275.42 / $1,380.38
| Professional | | $51.29 | $275.42 | $1,380.38 |