- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $1,548.82 / $6,025.60
| Facility | | $117.49 | $1,548.82 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $199.53 / $707.95
| Professional | | $70.79 | $199.53 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $100.00 / $128.82
| Professional | | $67.61 | $100.00 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $295.12 / $575.44
| Professional | | $114.82 | $295.12 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $602.56
| Facility | | $120.23 | $120.23 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $186.21 / $426.58
| Professional | | $85.11 | $186.21 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $165.96 / $346.74
| Facility | | $70.79 | $165.96 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $489.78
| Professional | | $186.21 | $186.21 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $724.44 / $1,949.84
| Facility | | $208.93 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $181.97 / $389.05
| Professional | | $72.44 | $181.97 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $6,165.95 / $6,165.95
| Facility | | $56.23 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,445.44
| Professional | | $1,202.26 | $1,202.26 | $1,445.44 |