- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $3,801.89 / $11,481.54
| Facility | | $81.28 | $3,801.89 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $87.10 / $234.42
| Professional | | $41.69 | $87.10 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $54.95 / $120.23
| Professional | | $20.42 | $54.95 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,621.81 / $3,162.28
| Facility | | $1,258.93 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $56.23 / $109.65
| Professional | | $33.88 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $154.88
| Professional | | $61.66 | $91.20 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $70.79 / $1,230.27
| Facility | | $39.81 | $70.79 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $112.20 / $223.87
| Professional | | $64.57 | $112.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $154.88
| Professional | | $64.57 | $107.15 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $125.89
| Professional | | $64.57 | $91.20 | $125.89 |
- 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
- $40.74 / $70.79 / $134.90
| Professional | | $40.74 | $70.79 | $134.90 |