- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $2,187.76 / $8,511.38
| Facility | | $36.31 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $48.98 / $190.55
| Professional | | $22.39 | $48.98 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $64.57
| Professional | | $41.69 | $41.69 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $323.59 / $630.96
| Facility | | $245.47 | $323.59 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $45.71 / $85.11
| Professional | | $27.54 | $45.71 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $85.11 / $134.90
| Professional | | $50.12 | $85.11 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $70.79 / $1,230.27
| Facility | | $25.12 | $70.79 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $93.33 / $338.84
| Professional | | $51.29 | $93.33 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $85.11 / $131.83
| Professional | | $51.29 | $85.11 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $100.00
| Professional | | $52.48 | $75.86 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Facility | | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $1,047.13 / $3,801.89
| Facility | | $72.44 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $56.23 / $104.71
| Professional | | $33.88 | $56.23 | $104.71 |