- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $977.24 / $6,456.54
| Facility | | $112.20 | $977.24 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $173.78 / $524.81
| Professional | | $56.23 | $173.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $102.33 / $436.52
| Professional | | $47.86 | $102.33 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $2,511.89 / $11,220.18
| Facility | | $154.88 | $2,511.89 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $125.89 / $251.19
| Professional | | $56.23 | $125.89 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $97.72 / $354.81
| Facility | | $45.71 | $97.72 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $141.25 / $363.08
| Professional | | $58.88 | $141.25 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $147.91 / $1,548.82
| Facility | | $120.23 | $147.91 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $162.18 / $331.13
| Professional | | $91.20 | $162.18 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $251.19
| Professional | | $32.36 | $44.67 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,412.54 / $3,630.78
| Facility | | $194.98 | $1,412.54 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $120.23 / $316.23
| Professional | | $53.70 | $120.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $131.83 / $245.47
| Professional | | $44.67 | $131.83 | $245.47 |