- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $165.96 / $4,677.35
| Facility | | $44.67 | $165.96 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $48.98 / $112.20
| Professional | | $28.18 | $48.98 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $57.54 / $95.50
| Professional | | $33.88 | $57.54 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $51.29 / $87.10 / $141.25
| Professional | 50 | $51.29 | $87.10 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $1,047.13
| Professional | | $33.11 | $39.81 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $85.11
| Professional | | $33.11 | $51.29 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $83.18
| Professional | | $52.48 | $69.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $66.07
| Professional | | $57.54 | $57.54 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $46.77 / $79.43
| Facility | | $29.51 | $46.77 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Professional | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $42.66 / $4,073.80
| Facility | | $27.54 | $42.66 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $67.61 / $4,073.80
| Professional | | $40.74 | $67.61 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,023.29 / $2,344.23
| Facility | | $204.17 | $1,023.29 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $45.71 / $77.62
| Professional | | $27.54 | $45.71 | $77.62 |