- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $741.31 / $5,495.41
| Facility | | $50.12 | $741.31 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $120.23 / $275.42
| Professional | | $40.74 | $120.23 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $120.23 / $162.18
| Professional | | $41.69 | $120.23 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $776.25
| Facility | | $169.82 | $208.93 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $97.72 / $151.36
| Professional | | $47.86 | $97.72 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $1,000.00
| Facility | | $50.12 | $50.12 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $97.72 / $218.78
| Professional | | $42.66 | $97.72 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $165.96 / $363.08
| Professional | | $53.70 | $165.96 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $51.29 / $151.36
| Professional | | $48.98 | $51.29 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $173.78
| Professional | | $32.36 | $33.11 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $645.65 / $2,089.30
| Facility | | $112.20 | $645.65 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $91.20 / $223.87
| Professional | | $40.74 | $91.20 | $223.87 |