- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $2,238.72 / $3,801.89
| Facility | | $354.81 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $275.42 / $562.34
| Professional | | $81.28 | $275.42 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $537.03 / $2,754.23
| Facility | | $56.23 | $537.03 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $309.03 / $1,000.00
| Professional | | $91.20 | $309.03 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $234.42
| Facility | | $100.00 | $100.00 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $234.42 / $707.95
| Professional | | $117.49 | $234.42 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $676.08 / $741.31
| Facility | | $229.09 | $676.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $281.84 / $776.25
| Professional | | $102.33 | $281.84 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $3,311.31
| Facility | | $83.18 | $120.23 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $524.81 / $776.25
| Professional | | $371.54 | $524.81 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,819.70 / $3,467.37
| Facility | | $229.09 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $346.74 / $891.25
| Professional | | $100.00 | $346.74 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $537.03 / $2,754.23
| Facility | | $56.23 | $537.03 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $309.03 / $1,000.00
| Professional | | $91.20 | $309.03 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,000.00 / $2,754.23
| Facility | | $309.03 | $1,000.00 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $309.03 / $933.25
| Professional | | $97.72 | $309.03 | $933.25 |