- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $2,630.27 / $8,317.64
| Facility | | $75.86 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $123.03 / $234.42
| Professional | | $61.66 | $123.03 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $151.36 / $275.42
| Professional | | $67.61 | $151.36 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $2,570.40
| Professional | | $61.66 | $72.44 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $147.91 / $524.81
| Facility | | $112.20 | $147.91 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $154.88 / $288.40
| Professional | | $70.79 | $154.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $213.80 / $457.09
| Professional | | $177.83 | $213.80 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $251.19 / $288.40
| Professional | | $223.87 | $251.19 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $154.88 / $281.84
| Facility | | $72.44 | $154.88 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $380.19
| Professional | | $138.04 | $138.04 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $794.33
| Facility | | $64.57 | $87.10 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $190.55 / $794.33
| Professional | | $134.90 | $190.55 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $2,511.89 / $5,370.32
| Facility | | $562.34 | $2,511.89 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $128.82 / $245.47
| Professional | | $60.26 | $128.82 | $245.47 |