- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $2,089.30 / $8,511.38
| Facility | | $128.82 | $2,089.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $380.19 / $2,238.72
| Professional | | $89.13 | $380.19 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $114.82 / $831.76
| Professional | | $77.62 | $114.82 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $4,168.69 / $12,302.69
| Facility | | $602.56 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $741.31 / $977.24
| Professional | | $85.11 | $741.31 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $3,981.07
| Facility | | $151.36 | $151.36 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $93.33
| Facility | 62 | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $645.65 / $2,187.76
| Professional | | $100.00 | $645.65 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,754.23 / $6,760.83
| Facility | | $1,348.96 | $2,754.23 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,202.26 / $1,819.70
| Professional | | $602.56 | $1,202.26 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $67.61 / $1,230.27
| Professional | | $32.36 | $67.61 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,479.11 / $3,630.78
| Facility | | $269.15 | $1,479.11 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $831.76 / $2,041.74
| Professional | | $87.10 | $831.76 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $676.08 / $912.01
| Professional | | $66.07 | $676.08 | $912.01 |