- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,023.29 / $2,818.38
| Facility | | $229.09 | $1,023.29 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $177.83 / $407.38
| Professional | | $100.00 | $177.83 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $114.82 / $169.82
| Professional | | $89.13 | $114.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $1,995.26 / $8,912.51
| Facility | | $123.03 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $141.25 / $257.04
| Professional | | $104.71 | $141.25 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $1,174.90 / $1,318.26
| Facility | | $173.78 | $1,174.90 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $177.83 / $354.81
| Professional | | $107.15 | $177.83 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $194.98
| Professional | | $107.15 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $81.28 / $199.53
| Professional | | $32.36 | $81.28 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,398.83 / $5,011.87
| Facility | | $575.44 | $2,398.83 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $173.78 / $363.08
| Professional | | $104.71 | $173.78 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $117.49 / $158.49
| Professional | | $81.28 | $117.49 | $158.49 |