- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $851.14 / $8,511.38
| Facility | | $158.49 | $851.14 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $169.82 / $245.47
| Professional | | $141.25 | $169.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $10,715.19 / $11,220.18
| Facility | | $5,011.87 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $125.89 / $199.53
| Professional | | $107.15 | $125.89 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $302.00
| Professional | 50 | $162.18 | $190.55 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $154.88 / $194.98
| Facility | | $117.49 | $154.88 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $181.97 / $223.87
| Professional | | $123.03 | $181.97 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $245.47 / $245.47
| Facility | | $34.67 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $199.53 / $2,290.87
| Professional | | $125.89 | $199.53 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $63.10
| Professional | | $32.36 | $33.11 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $3,388.44 / $6,025.60
| Facility | | $602.56 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $158.49 / $275.42
| Professional | | $128.82 | $158.49 | $275.42 |