- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $776.25 / $7,585.78
| Facility | | $138.04 | $776.25 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $138.04 / $501.19
| Professional | | $54.95 | $138.04 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $109.65 / $257.04
| Professional | | $46.77 | $109.65 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,122.02 / $2,290.87
| Facility | | $891.25 | $1,122.02 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $120.23 / $245.47
| Professional | | $69.18 | $120.23 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $181.97 / $380.19
| Professional | | $120.23 | $181.97 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $398.11 / $1,258.93
| Facility | | $102.33 | $398.11 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $251.19 / $954.99
| Professional | | $112.20 | $251.19 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $239.88 / $346.74
| Professional | | $138.04 | $239.88 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $186.21 / $281.84
| Professional | | $131.83 | $186.21 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $831.76 / $912.01
| Facility | | $724.44 | $831.76 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,047.13 / $3,801.89
| Facility | | $501.19 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $141.25 / $302.00
| Professional | | $75.86 | $141.25 | $302.00 |