- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $1,230.27
| Facility | | $57.54 | $83.18 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $57.54 / $95.50
| Professional | | $39.81 | $57.54 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,288.25 / $1,318.26
| Facility | | $1,122.02 | $1,288.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $54.95 / $93.33
| Professional | | $39.81 | $54.95 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $39.81 / $56.23
| Facility | | $16.22 | $39.81 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $204.17 / $1,621.81
| Facility | | $109.65 | $204.17 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $66.07 / $128.82
| Professional | | $45.71 | $66.07 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $91.20 / $1,621.81
| Facility | | $42.66 | $91.20 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $64.57 / $112.20
| Professional | | $44.67 | $64.57 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $33.11
| Professional | | $20.89 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Facility | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $131.83
| Professional | | $60.26 | $70.79 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $407.38 / $1,258.93
| Facility | | $19.05 | $407.38 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $56.23 / $95.50
| Professional | | $40.74 | $56.23 | $95.50 |