- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $257.04 / $5,495.41
| Facility | | $131.83 | $257.04 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $154.88
| Professional | | $52.48 | $79.43 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $162.18 / $331.13
| Facility | | $57.54 | $162.18 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $134.90
| Professional | | $83.18 | $104.71 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $147.91 / $204.17
| Professional | 50 | $125.89 | $147.91 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $81.28 / $117.49
| Professional | | $52.48 | $81.28 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $112.20 / $257.04
| Facility | | $50.12 | $112.20 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $144.54
| Professional | | $53.70 | $87.10 | $144.54 |
- 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
- $229.09 / $288.40 / $407.38
| Facility | | $229.09 | $288.40 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $102.33 / $141.25
| Professional | | $91.20 | $102.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $85.11 / $229.09
| Professional | | $61.66 | $85.11 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $8,317.64 / $9,332.54
| Facility | | $181.97 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $125.89
| Professional | | $56.23 | $81.28 | $125.89 |