- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $173.78 / $977.24
| Facility | | $42.66 | $173.78 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $25.12 / $141.25
| Professional | | $14.13 | $25.12 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $251.19 / $575.44
| Facility | | $154.88 | $251.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $33.11 / $35.48
| Professional | | $30.90 | $33.11 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Facility | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $43.65 / $51.29
| Professional | | $40.74 | $43.65 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $42.66 / $208.93
| Facility | | $12.88 | $42.66 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $21.38 / $389.05
| Professional | | $12.88 | $21.38 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Professional | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $6,918.31 / $8,128.31
| Facility | | $6,918.31 | $6,918.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $12.88 / $42.66
| Facility | | $7.76 | $12.88 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $21.38 / $56.23
| Professional | | $20.42 | $21.38 | $56.23 |