- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $616.60 / $5,495.41
| Facility | | $120.23 | $616.60 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $177.83 / $363.08
| Professional | | $77.62 | $177.83 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $524.81 / $1,047.13
| Facility | | $223.87 | $524.81 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $281.84 / $363.08
| Professional | | $141.25 | $281.84 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $223.87 / $354.81
| Professional | | $104.71 | $223.87 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $537.03
| Professional | | $446.68 | $446.68 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $208.93 / $478.63
| Facility | | $87.10 | $208.93 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $208.93 / $478.63
| Professional | | $117.49 | $208.93 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $75.86 / $120.23
| Professional | | $32.36 | $75.86 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $204.17 / $407.38
| Professional | | $151.36 | $204.17 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $165.96 / $389.05
| Professional | | $117.49 | $165.96 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $8,317.64 / $9,332.54
| Facility | | $1,819.70 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $194.98 / $363.08
| Professional | | $91.20 | $194.98 | $363.08 |