- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $3,715.35 / $12,022.64
| Facility | | $524.81 | $3,715.35 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $53.70 / $81.28
| Professional | | $36.31 | $53.70 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | 50 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Professional | | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Professional | 50 | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $588.84 / $1,230.27
| Facility | | $288.40 | $588.84 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $58.88
| Professional | | $32.36 | $40.74 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $97.72 / $630.96
| Facility | | $34.67 | $97.72 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $38.90
| Facility | | $29.51 | $29.51 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $56.23 / $109.65
| Professional | | $38.02 | $56.23 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $1,513.56
| Facility | | $54.95 | $56.23 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Professional | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $60.26 / $3,715.35
| Facility | | $37.15 | $60.26 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $51.29 / $87.10
| Professional | | $36.31 | $51.29 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | 50 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $56.23
| Professional | | $32.36 | $38.90 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $51.29 / $97.72
| Facility | | $35.48 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $56.23 / $109.65
| Professional | | $37.15 | $56.23 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $851.14 / $2,290.87
| Facility | | $162.18 | $851.14 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $83.18
| Professional | | $34.67 | $52.48 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Professional | | $38.90 | $38.90 | $38.90 |