- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $3,235.94 / $8,912.51
| Facility | | $23.99 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $33.11 / $112.20
| Professional | | $19.50 | $33.11 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.95 / $169.82 / $323.59
| Professional | 50 | $19.95 | $169.82 | $323.59 |
- 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
- $20.42 / $29.51 / $43.65
| Professional | | $20.42 | $29.51 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $64.57
| Professional | 50 | $30.20 | $45.71 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $23.99 / $1,047.13
| Professional | | $21.88 | $23.99 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Facility | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $40.74 / $70.79
| Professional | | $19.05 | $40.74 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $20.89 / $26.92
| Professional | | $17.78 | $20.89 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $107.15
| Professional | | $85.11 | $85.11 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $37.15 / $83.18
| Facility | | $20.42 | $37.15 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $60.26 / $4,073.80
| Facility | | $25.12 | $60.26 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $61.66 / $4,073.80
| Professional | | $23.44 | $61.66 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,047.13 / $2,344.23
| Facility | | $204.17 | $1,047.13 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $38.90 / $72.44
| Professional | | $20.42 | $38.90 | $72.44 |