- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $117.49 / $4,365.16
| Facility | | $38.02 | $117.49 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $117.49 / $295.12
| Professional | | $39.81 | $117.49 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Facility | | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $245.47 / $251.19
| Professional | | $138.04 | $245.47 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $138.04 / $346.74
| Professional | | $77.62 | $138.04 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $93.33 / $245.47
| Facility | | $35.48 | $93.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $177.83 / $870.96
| Professional | | $91.20 | $177.83 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $102.33 / $239.88
| Professional | | $91.20 | $102.33 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $213.80
| Professional | | $85.11 | $85.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $117.49 / $223.87
| Professional | | $60.26 | $117.49 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $97.72 / $251.19
| Professional | | $46.77 | $97.72 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $97.72 / $269.15
| Professional | | $79.43 | $97.72 | $269.15 |