- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $3,090.30 / $8,511.38
| Facility | | $501.19 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $87.10 / $169.82
| Professional | | $58.88 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $87.10
| Professional | | $43.65 | $43.65 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $4,168.69 / $12,302.69
| Facility | | $85.11 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $100.00
| Professional | | $61.66 | $79.43 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $48.98 / $112.20
| Facility | | $47.86 | $48.98 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $154.88
| Professional | | $63.10 | $97.72 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,691.53 / $5,011.87
| Facility | | $1,737.80 | $2,691.53 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $74.13 / $97.72
| Professional | | $43.65 | $74.13 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $114.82
| Professional | | $32.36 | $45.71 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,445.44 / $3,630.78
| Facility | | $263.03 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $79.43 / $144.54
| Professional | | $53.70 | $79.43 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $100.00
| Professional | | $51.29 | $67.61 | $100.00 |