- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $389.05 / $7,943.28
| Facility | | $138.04 | $389.05 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $173.78 / $512.86
| Professional | | $67.61 | $173.78 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $275.42
| Professional | | $100.00 | $141.25 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $660.69 / $1,348.96
| Facility | | $524.81 | $660.69 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $128.82 / $239.88
| Professional | | $77.62 | $128.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $204.17 / $380.19
| Professional | | $114.82 | $204.17 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $223.87 / $562.34
| Facility | | $107.15 | $223.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $234.42 / $954.99
| Professional | | $158.49 | $234.42 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $263.03 / $331.13
| Professional | | $151.36 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $281.84
| Professional | | $151.36 | $151.36 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $190.55 / $346.74
| Professional | | $6.03 | $190.55 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $1,047.13 / $3,801.89
| Facility | | $245.47 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $162.18 / $302.00
| Professional | | $87.10 | $162.18 | $302.00 |