- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $85.11 / $177.83
| Professional | | $47.86 | $85.11 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $371.54 / $707.95
| Facility | | $288.40 | $371.54 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $426.58 / $512.86 / $1,071.52
| Facility | 50 | $426.58 | $512.86 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $109.65 / $141.25
| Professional | | $83.18 | $109.65 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $131.83
| Professional | | $57.54 | $89.13 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $93.33 / $204.17
| Facility | | $47.86 | $93.33 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $154.88
| Professional | | $74.13 | $117.49 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $102.33 / $147.91
| Professional | | $81.28 | $102.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $162.18
| Professional | | $54.95 | $75.86 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,819.70 / $9,332.54
| Facility | | $151.36 | $1,819.70 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $141.25
| Professional | | $60.26 | $91.20 | $141.25 |