- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $2,187.76 / $3,715.35
| Facility | | $53.70 | $2,187.76 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $74.13 / $602.56
| Professional | | $43.65 | $74.13 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $501.19 / $2,818.38
| Facility | | $56.23 | $501.19 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $85.11 / $194.98
| Professional | | $47.86 | $85.11 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $138.04
| Facility | | $61.66 | $61.66 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $72.44 / $117.49
| Professional | | $52.48 | $72.44 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $87.10 / $190.55
| Professional | | $57.54 | $87.10 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $69.18 / $3,630.78
| Facility | | $47.86 | $69.18 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $100.00 / $128.82
| Professional | | $85.11 | $100.00 | $128.82 |
- 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
- $57.54 / $93.33 / $190.55
| Professional | | $57.54 | $93.33 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $501.19 / $2,818.38
| Facility | | $56.23 | $501.19 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $85.11 / $194.98
| Professional | | $47.86 | $85.11 | $194.98 |
- 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 / $93.33 / $186.21
| Professional | | $52.48 | $93.33 | $186.21 |