- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $128.82 / $204.17
| Professional | | $51.29 | $128.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $17.38
| Professional | | $5.13 | $5.13 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $12.88 / $12.88
| Facility | | $7.76 | $12.88 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $12.88 / $12.88
| Professional | | $9.33 | $12.88 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50,118.72 / $53,703.18
| Facility | | $50.12 | $50,118.72 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $28.18
| Professional | | $22.91 | $22.91 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $5.01
| Professional | | $5.01 | $5.01 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $5.01
| Facility | | $5.01 | $5.01 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $6.46
| Professional | | $5.01 | $5.01 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $50,118.72 / $75,857.76
| Facility | | $10.96 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $21.38 / $25.12
| Facility | | $19.05 | $21.38 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $67.61 / $75.86
| Professional | | $50.12 | $67.61 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $6.03
| Facility | | $5.01 | $5.01 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.25 / $23.99
| Professional | | $5.01 | $5.25 | $23.99 |