- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $117.49 / $7,585.78
| Facility | | $87.10 | $117.49 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $93.33 / $181.97
| Professional | | $64.57 | $93.33 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $83.18
| Facility | | $81.28 | $81.28 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $123.03 / $257.04
| Professional | | $74.13 | $123.03 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $602.56
| Facility | | $120.23 | $120.23 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $112.20 / $190.55
| Professional | | $70.79 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $223.87
| Professional | | $141.25 | $141.25 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $102.33 / $169.82
| Facility | | $67.61 | $102.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $239.88
| Professional | | $151.36 | $194.98 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $724.44 / $1,949.84
| Facility | | $213.80 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $169.82
| Professional | | $61.66 | $91.20 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,288.25 / $1,288.25
| Facility | | $56.23 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $891.25
| Professional | | $741.31 | $741.31 | $891.25 |