- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $2,570.40 / $6,606.93
| Facility | | $147.91 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $416.87 / $2,570.40
| Professional | | $87.10 | $416.87 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $85.11 / $162.18
| Professional | | $77.62 | $85.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,412.54 / $3,630.78
| Professional | | $141.25 | $1,412.54 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $602.56
| Facility | | $151.36 | $151.36 | $602.56 |
- 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
- $107.15 / $323.59 / $2,570.40
| Professional | | $107.15 | $323.59 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $2,630.27
| Professional | | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $794.33 / $2,089.30
| Facility | | $89.13 | $794.33 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $3,019.95
| Professional | | $1,230.27 | $1,230.27 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $562.34 / $2,754.23
| Professional | | $123.03 | $562.34 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $812.83 / $1,995.26
| Facility | | $208.93 | $812.83 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $933.25 / $2,398.83
| Professional | | $91.20 | $933.25 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $8,128.31 / $8,128.31
| Facility | | $56.23 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | 62 | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $6,760.83 / $7,585.78
| Professional | | $6,760.83 | $6,760.83 | $7,585.78 |