- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $933.25 / $7,943.28
| Facility | | $107.15 | $933.25 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $194.98 / $602.56
| Professional | | $56.23 | $194.98 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $218.78 / $489.78
| Professional | | $43.65 | $218.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $181.97 / $562.34
| Professional | | $89.13 | $181.97 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $158.49 / $616.60
| Professional | | $63.10 | $158.49 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $144.54 / $524.81
| Facility | | $79.43 | $144.54 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $141.25 / $537.03
| Professional | | $72.44 | $141.25 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $35.48
| Professional | | $32.36 | $33.11 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $371.54 / $457.09
| Facility | | $190.55 | $371.54 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $346.74 / $346.74
| Facility | | $331.13 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $331.13 / $602.56
| Professional | | $83.18 | $331.13 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $181.97 / $524.81
| Professional | | $89.13 | $181.97 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $660.69 / $5,754.40
| Facility | | $316.23 | $660.69 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $165.96 / $489.78
| Professional | | $72.44 | $165.96 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $107.15 / $346.74
| Professional | | $57.54 | $107.15 | $346.74 |