- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $1,949.84 / $7,079.46
| Facility | | $120.23 | $1,949.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $151.36 / $309.03
| Professional | | $91.20 | $151.36 | $309.03 |
- 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
- $89.13 / $134.90 / $186.21
| Professional | | $89.13 | $134.90 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $100.00 / $2,511.89
| Professional | | $89.13 | $100.00 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $162.18 / $281.84
| Professional | | $91.20 | $162.18 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $208.93 / $263.03
| Professional | | $79.43 | $208.93 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $457.09
| Professional | | $446.68 | $446.68 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $177.83 / $331.13
| Facility | | $95.50 | $177.83 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $4,073.80
| Facility | | $87.10 | $128.82 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $239.88 / $4,073.80
| Professional | | $169.82 | $239.88 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,162.28 / $5,370.32
| Facility | | $1,737.80 | $3,162.28 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $141.25 / $263.03
| Professional | | $77.62 | $141.25 | $263.03 |