- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $630.96 / $3,715.35
| Facility | | $138.04 | $630.96 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $120.23 / $223.87
| Professional | | $72.44 | $120.23 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $35.48 / $45.71
| Professional | | $25.70 | $35.48 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $67.61 / $125.89
| Facility | | $45.71 | $67.61 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $107.15
| Professional | | $61.66 | $95.50 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $123.03 / $169.82
| Facility | | $35.48 | $123.03 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $120.23 / $257.04
| Professional | | $34.67 | $120.23 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $229.09 / $302.00
| Facility | | $74.13 | $229.09 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $114.82 / $331.13
| Professional | | $70.79 | $114.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $323.59
| Professional | | $37.15 | $47.86 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $933.25 / $2,630.27
| Facility | | $630.96 | $933.25 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $48.98 / $186.21
| Professional | | $35.48 | $48.98 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $177.83
| Professional | | $60.26 | $100.00 | $177.83 |