- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $977.24 / $5,128.61
| Facility | | $93.33 | $977.24 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $162.18 / $524.81
| Professional | | $54.95 | $162.18 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $77.62 / $398.11
| Professional | | $48.98 | $77.62 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $309.03 / $645.65
| Professional | | $81.28 | $309.03 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $1,288.25
| Facility | | $398.11 | $398.11 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $181.97 / $457.09
| Professional | | $67.61 | $181.97 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $562.34
| Professional | | $426.58 | $426.58 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $199.53 / $426.58
| Facility | | $57.54 | $199.53 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $407.38 / $512.86
| Professional | | $316.23 | $407.38 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $3,548.13 / $6,760.83
| Facility | | $1,258.93 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $169.82 / $398.11
| Professional | | $53.70 | $169.82 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $19,498.45
| Facility | | $4,168.69 | $4,168.69 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,778.28
| Professional | | $1,584.89 | $1,584.89 | $1,778.28 |