- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $275.42 / $630.96
| Facility | | $112.20 | $275.42 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $87.10 / $144.54
| Professional | | $70.79 | $87.10 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $95.50 / $162.18
| Professional | | $91.20 | $95.50 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $223.87 / $575.44
| Facility | | $97.72 | $223.87 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $100.00 / $177.83
| Professional | | $66.07 | $100.00 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $138.04 / $173.78
| Professional | | $104.71 | $138.04 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $104.71 / $190.55
| Professional | | $47.86 | $104.71 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $275.42
| Facility | | $100.00 | $158.49 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $87.10 / $125.89
| Professional | | $70.79 | $87.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $128.82 / $204.17
| Professional | | $83.18 | $128.82 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $51.29 / $93.33
| Facility | | $15.14 | $51.29 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $45.71 / $309.03
| Professional | | $10.00 | $45.71 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $707.95 / $812.83
| Facility | | $426.58 | $707.95 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $173.78
| Professional | | $63.10 | $93.33 | $173.78 |