- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $645.65 / $5,754.40
| Facility | | $177.83 | $645.65 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $275.42 / $1,174.90
| Professional | | $131.83 | $275.42 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $407.38 / $1,122.02
| Professional | | $208.93 | $407.38 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $776.25 / $1,230.27
| Facility | | $660.69 | $776.25 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $416.87 / $794.33
| Professional | | $186.21 | $416.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $512.86 / $3,801.89
| Facility | | $154.88 | $512.86 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $426.58 / $741.31
| Professional | | $275.42 | $426.58 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $2,137.96 / $5,754.40
| Facility | | $173.78 | $2,137.96 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $489.78 / $1,479.11
| Professional | | $251.19 | $489.78 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $426.58
| Professional | | $32.36 | $33.11 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $3,890.45 / $4,570.88
| Facility | | $295.12 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $588.84 / $1,000.00
| Professional | | $331.13 | $588.84 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $446.68 / $977.24
| Professional | | $234.42 | $446.68 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $4,466.84 / $4,466.84
| Facility | | $3,019.95 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $3,630.78
| Facility | 52 | $2,454.71 | $2,454.71 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $741.31 / $1,819.70
| Professional | | $181.97 | $741.31 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $616.60
| Professional | | $316.23 | $316.23 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $776.25 / $1,513.56
| Professional | | $562.34 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,630.78 / $6,606.93
| Facility | | $2,884.03 | $3,630.78 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $371.54 / $912.01
| Professional | | $165.96 | $371.54 | $912.01 |