- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $251.19 / $3,890.45
| Facility | | $58.88 | $251.19 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $107.15 / $213.80
| Professional | | $58.88 | $107.15 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $117.49 / $151.36
| Professional | | $107.15 | $117.49 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,137.96 / $2,951.21
| Facility | | $1,258.93 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $112.20 / $169.82
| Professional | | $74.13 | $112.20 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $87.10
| Facility | | $56.23 | $74.13 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $97.72 / $131.83
| Professional | | $64.57 | $97.72 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $107.15 / $107.15
| Facility | | $34.67 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $10.72
| Facility | AS | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $131.83 / $724.44
| Professional | | $66.07 | $131.83 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $602.56 / $1,949.84
| Facility | | $58.88 | $602.56 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $165.96
| Professional | | $67.61 | $107.15 | $165.96 |