- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $1,698.24 / $7,943.28
| Facility | | $123.03 | $1,698.24 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $40.74 / $123.03
| Professional | | $14.13 | $40.74 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $63.10 / $91.20
| Professional | | $24.55 | $63.10 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $4,265.80 / $12,302.69
| Facility | | $74.13 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $54.95 / $72.44
| Professional | | $14.45 | $54.95 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $26.92
| Facility | | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $39.81 / $91.20
| Professional | | $14.13 | $39.81 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,630.27 / $4,466.84
| Facility | | $1,548.82 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $47.86 / $75.86
| Professional | | $23.99 | $47.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $33.11 / $97.72
| Professional | | $12.30 | $33.11 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $1,445.44 / $3,630.78
| Facility | | $234.42 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $35.48 / $75.86
| Professional | | $13.18 | $35.48 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $52.48 / $72.44
| Professional | | $11.75 | $52.48 | $72.44 |