- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $13,489.63 / $14,454.40
| Facility | | $77.62 | $13,489.63 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $48.98 / $102.33
| Professional | | $16.98 | $48.98 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $60.26 / $151.36
| Professional | | $21.88 | $60.26 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $74.13 / $151.36
| Professional | | $30.20 | $74.13 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $58.88 / $141.25
| Facility | | $20.89 | $58.88 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $134.90 / $537.03
| Professional | | $56.23 | $134.90 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $104.71 / $190.55
| Professional | | $37.15 | $104.71 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $87.10 / $186.21
| Professional | | $37.15 | $87.10 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $151.36 / $223.87
| Professional | | $25.12 | $151.36 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.07 / $0.07 / $0.07
| Facility | | $0.07 | $0.07 | $0.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $57.54 / $169.82
| Professional | | $26.30 | $57.54 | $169.82 |