- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $2,238.72 / $10,715.19
| Facility | | $112.20 | $2,238.72 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $144.54 / $316.23
| Professional | | $61.66 | $144.54 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Professional | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,691.53 / $7,943.28
| Facility | | $954.99 | $2,691.53 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $245.47
| Professional | | $95.50 | $147.91 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $67.61 / $154.88
| Facility | | $61.66 | $67.61 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $75.86
| Professional | | $67.61 | $67.61 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $575.44
| Facility | | $79.43 | $109.65 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $154.88 / $295.12
| Professional | | $70.79 | $154.88 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $177.83 / $575.44
| Facility | | $109.65 | $177.83 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $158.49 / $281.84
| Professional | | $70.79 | $158.49 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $60.26
| Professional | | $32.36 | $33.11 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $741.31
| Facility | | $100.00 | $100.00 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $165.96 / $269.15
| Professional | | $63.10 | $165.96 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,290.87 / $4,897.79
| Facility | | $724.44 | $2,290.87 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $117.49 / $223.87
| Professional | | $60.26 | $117.49 | $223.87 |