- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $5,495.41
| Facility | | $51.29 | $81.28 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $44.67 / $114.82
| Professional | | $22.39 | $44.67 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $107.15 / $186.21
| Facility | | $54.95 | $107.15 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $87.10
| Professional | | $38.02 | $54.95 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $131.83
| Professional | 50 | $61.66 | $102.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $74.13
| Professional | | $33.11 | $44.67 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $48.98 / $91.20
| Facility | | $23.44 | $48.98 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $60.26 / $91.20
| Professional | | $35.48 | $60.26 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $138.04 / $199.53
| Facility | | $109.65 | $138.04 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $50.12 / $85.11
| Professional | | $35.48 | $50.12 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $41.69 / $147.91
| Professional | | $37.15 | $41.69 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $8,317.64 / $9,332.54
| Facility | | $1,819.70 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $74.13
| Professional | | $27.54 | $44.67 | $74.13 |