- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $707.95 / $6,760.83
| Facility | | $213.80 | $707.95 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $154.88 / $323.59
| Professional | | $89.13 | $154.88 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $120.23 / $199.53
| Professional | | $95.50 | $120.23 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $2,570.40 / $11,220.18
| Facility | | $125.89 | $2,570.40 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $109.65 / $131.83
| Professional | | $95.50 | $109.65 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $81.28 / $177.83
| Facility | | $79.43 | $81.28 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Facility | 54 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $123.03 / $204.17
| Professional | | $85.11 | $123.03 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,630.27 / $4,466.84
| Facility | | $1,584.89 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $95.50 / $141.25
| Professional | | $89.13 | $95.50 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $104.71 / $186.21
| Professional | | $32.36 | $104.71 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $1,445.44 / $3,630.78
| Facility | | $234.42 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $102.33 / $190.55
| Professional | | $74.13 | $102.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $97.72 / $131.83
| Professional | | $83.18 | $97.72 | $131.83 |