- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $2,187.76 / $8,511.38
| Facility | | $112.20 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $190.55 / $446.68
| Professional | | $58.88 | $190.55 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $141.25 / $173.78
| Professional | | $81.28 | $141.25 | $173.78 |
- 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
- $61.66 / $104.71 / $213.80
| Professional | | $61.66 | $104.71 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $316.23
| Professional | | $109.65 | $162.18 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $190.55 / $616.60
| Facility | | $87.10 | $190.55 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $223.87 / $851.14
| Professional | | $123.03 | $223.87 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $213.80 / $316.23
| Professional | | $123.03 | $213.80 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $165.96 / $257.04
| Professional | | $120.23 | $165.96 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,047.13 / $3,801.89
| Facility | | $251.19 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $131.83 / $269.15
| Professional | | $74.13 | $131.83 | $269.15 |