- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $776.25 / $5,888.44
| Facility | | $64.57 | $776.25 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $117.49 / $309.03
| Professional | | $36.31 | $117.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $114.82 / $295.12
| Professional | | $38.90 | $114.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $933.25
| Professional | | $34.67 | $47.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Facility | | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $97.72 / $316.23
| Professional | | $40.74 | $97.72 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $204.17 / $275.42
| Professional | | $169.82 | $204.17 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $251.19 / $436.52
| Professional | | $69.18 | $251.19 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $134.90 / $309.03
| Facility | | $40.74 | $134.90 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $52.48 / $1,258.93
| Facility | | $37.15 | $52.48 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $218.78 / $1,318.26
| Professional | | $131.83 | $218.78 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,000.00 / $2,344.23
| Facility | | $204.17 | $1,000.00 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $112.20 / $302.00
| Professional | | $35.48 | $112.20 | $302.00 |