- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $213.80 / $5,888.44
| Facility | | $53.70 | $213.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $107.15 / $263.03
| Professional | | $39.81 | $107.15 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $102.33 / $194.98
| Professional | | $42.66 | $102.33 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $48.98 / $812.83
| Professional | | $41.69 | $48.98 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $69.18
| Facility | | $51.29 | $51.29 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $89.13 / $218.78
| Professional | | $40.74 | $89.13 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $151.36 / $257.04
| Professional | | $120.23 | $151.36 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $128.82
| Professional | | $97.72 | $120.23 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $87.10 / $186.21
| Facility | | $40.74 | $87.10 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $190.55
| Professional | | $34.67 | $34.67 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $47.86 / $302.00
| Facility | | $38.90 | $47.86 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $478.63
| Professional | | $83.18 | $120.23 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $812.83 / $2,344.23
| Facility | | $141.25 | $812.83 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $75.86 / $158.49
| Professional | | $34.67 | $75.86 | $158.49 |