- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $436.52 / $6,456.54
| Facility | | $120.23 | $436.52 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $83.18 / $257.04
| Professional | | $41.69 | $83.18 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $117.49
| Facility | | $114.82 | $114.82 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $177.83 / $331.13
| Professional | | $75.86 | $177.83 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $398.11
| Facility | | $87.10 | $87.10 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $131.83 / $251.19
| Professional | | $60.26 | $131.83 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $245.47
| Professional | | $190.55 | $190.55 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $104.71 / $239.88
| Facility | | $45.71 | $104.71 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $125.89 / $269.15
| Professional | | $61.66 | $125.89 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $2,137.96 / $4,265.80
| Facility | | $549.54 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $102.33 / $208.93
| Professional | | $43.65 | $102.33 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,288.25 / $1,288.25
| Facility | | $56.23 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | | $1,023.29 | $1,023.29 | $1,023.29 |