- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $316.23 / $6,025.60
| Facility | | $109.65 | $316.23 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $169.82 / $524.81
| Professional | | $48.98 | $169.82 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $87.10 / $218.78
| Professional | | $57.54 | $87.10 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $741.31 / $1,513.56
| Facility | | $588.84 | $741.31 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $107.15 / $208.93
| Professional | | $61.66 | $107.15 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $165.96 / $263.03
| Professional | | $107.15 | $165.96 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $239.88 / $549.54
| Facility | | $102.33 | $239.88 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $229.09 / $912.01
| Professional | | $128.82 | $229.09 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $204.17 / $309.03
| Professional | | $120.23 | $204.17 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $165.96 / $245.47
| Professional | | $117.49 | $165.96 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $2,290.87
| Facility | | $1,949.84 | $1,949.84 | $2,290.87 |
- 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
- $72.44 / $134.90 / $263.03
| Professional | | $72.44 | $134.90 | $263.03 |