- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $3,090.30 / $9,332.54
| Facility | | $100.00 | $3,090.30 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $112.20 / $251.19
| Professional | | $46.77 | $112.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $42.66 / $263.03
| Professional | | $21.38 | $42.66 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $3,630.78 / $12,302.69
| Facility | | $114.82 | $3,630.78 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $104.71 / $154.88
| Professional | | $46.77 | $104.71 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $95.50 / $371.54
| Facility | | $83.18 | $95.50 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $109.65 / $234.42
| Professional | | $46.77 | $109.65 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,388.44 / $7,585.78
| Facility | | $2,238.72 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $102.33 / $169.82
| Professional | | $51.29 | $102.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $37.15 / $162.18
| Professional | | $32.36 | $37.15 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $2,137.96 / $5,011.87
| Facility | | $501.19 | $2,137.96 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $85.11 / $177.83
| Professional | | $39.81 | $85.11 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $100.00 / $154.88
| Professional | | $37.15 | $100.00 | $154.88 |