- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $426.58 / $1,023.29
| Facility | | $70.79 | $426.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $190.55
| Professional | | $57.54 | $89.13 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $89.13 / $154.88
| Professional | | $77.62 | $89.13 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $1,445.44 / $9,772.37
| Facility | | $60.26 | $1,445.44 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $74.13 / $91.20
| Professional | | $60.26 | $74.13 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $52.48 / $100.00
| Facility | | $50.12 | $52.48 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $91.20 / $154.88
| Professional | | $56.23 | $91.20 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,466.84
| Facility | | $1,698.24 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $69.18 / $91.20
| Professional | | $45.71 | $69.18 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $47.86 / $112.20
| Professional | | $32.36 | $47.86 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,445.44 / $3,630.78
| Facility | | $251.19 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $74.13 / $134.90
| Professional | | $48.98 | $74.13 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $64.57 / $91.20
| Professional | | $45.71 | $64.57 | $91.20 |