- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $3,801.89 / $12,589.25
| Facility | | $117.49 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $107.15 / $239.88
| Professional | | $28.84 | $107.15 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | | $51.29 | $51.29 | $51.29 |
- 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
- $37.15 / $61.66 / $109.65
| Professional | | $37.15 | $61.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $134.90
| Professional | | $63.10 | $95.50 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $93.33 / $1,230.27
| Facility | | $45.71 | $93.33 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $107.15 / $426.58
| Professional | | $61.66 | $107.15 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $109.65 / $147.91
| Professional | | $70.79 | $109.65 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $95.50 / $128.82
| Professional | | $74.13 | $95.50 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $1,047.13 / $3,801.89
| Facility | | $165.96 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $70.79 / $134.90
| Professional | | $41.69 | $70.79 | $134.90 |