- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $7,943.28 / $14,454.40
| Facility | | $109.65 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $109.65 / $331.13
| Professional | | $53.70 | $109.65 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $691.83 / $1,348.96
| Facility | | $524.81 | $691.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $112.20 / $204.17
| Professional | | $69.18 | $112.20 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $181.97 / $323.59
| Professional | | $104.71 | $181.97 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $162.18 / $1,230.27
| Facility | | $70.79 | $162.18 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $223.87 / $851.14
| Professional | | $144.54 | $223.87 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $239.88 / $323.59
| Professional | | $131.83 | $239.88 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $239.88
| Professional | | $131.83 | $131.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $97.72 / $302.00
| Professional | | $5.01 | $97.72 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,047.13 / $3,801.89
| Facility | | $676.08 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $144.54 / $263.03
| Professional | | $75.86 | $144.54 | $263.03 |