- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $2,630.27 / $8,317.64
| Facility | | $75.86 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $478.63 / $977.24
| Professional | | $64.57 | $478.63 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $331.13 / $1,047.13
| Professional | | $70.79 | $331.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $74.13 / $2,630.27
| Professional | | $64.57 | $74.13 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $562.34 / $691.83
| Facility | | $489.78 | $562.34 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $288.40 / $1,047.13
| Professional | | $69.18 | $288.40 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $851.14 / $1,412.54
| Professional | | $676.08 | $851.14 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $588.84 / $912.01
| Professional | | $467.74 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $346.74 / $1,096.48
| Facility | | $69.18 | $346.74 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $977.24
| Professional | | $50.12 | $50.12 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $870.96
| Facility | | $66.07 | $87.10 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $741.31 / $2,137.96
| Professional | | $467.74 | $741.31 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,511.89 / $5,370.32
| Facility | | $575.44 | $2,511.89 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $165.96 / $1,000.00
| Professional | | $60.26 | $165.96 | $1,000.00 |