- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,548.82 / $6,760.83
| Facility | | $588.84 | $1,548.82 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $213.80 / $1,621.81
| Professional | | $87.10 | $213.80 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $97.72 / $102.33
| Professional | | $91.20 | $97.72 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $251.19 / $354.81
| Facility | | $181.97 | $251.19 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $1,023.29 / $1,412.54
| Professional | | $87.10 | $1,023.29 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Facility | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $1,819.70
| Professional | | $100.00 | $147.91 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $776.25 / $1,862.09
| Facility | | $102.33 | $776.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 62
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | 62 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,621.81 / $6,760.83
| Professional | | $1,047.13 | $1,621.81 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $616.60 / $1,621.81
| Facility | | $138.04 | $616.60 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $831.76 / $1,819.70
| Professional | | $85.11 | $831.76 | $1,819.70 |