- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $1,000.00 / $3,388.44
| Facility | | $69.18 | $1,000.00 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $61.66 / $251.19
| Professional | | $42.66 | $61.66 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $1,000.00 / $2,818.38
| Facility | | $114.82 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $77.62 / $162.18
| Professional | | $44.67 | $77.62 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $128.82
| Facility | | $56.23 | $56.23 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $95.50 / $144.54
| Professional | | $56.23 | $95.50 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $107.15 / $181.97
| Professional | | $70.79 | $107.15 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $3,630.78
| Facility | | $47.86 | $63.10 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $83.18 / $117.49
| Professional | | $67.61 | $83.18 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $154.88
| Professional | | $52.48 | $83.18 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $676.08 / $3,890.45
| Facility | | $77.62 | $676.08 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $123.03 / $125.89
| Professional | | $51.29 | $123.03 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $1,000.00 / $2,818.38
| Facility | | $114.82 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $77.62 / $162.18
| Professional | | $44.67 | $77.62 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,862.09 / $2,818.38
| Facility | | $524.81 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $162.18
| Professional | | $52.48 | $89.13 | $162.18 |