- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $1,862.09
| Facility | | $33.11 | $33.11 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $42.66
| Professional | | $25.12 | $30.20 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $31.62 / $51.29
| Professional | | $26.92 | $31.62 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $70.79 / $91.20
| Facility | | $36.31 | $70.79 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $39.81 / $151.36
| Professional | | $12.88 | $39.81 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Facility | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $72.44
| Professional | | $36.31 | $50.12 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $57.54
| Professional | | $25.70 | $38.90 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Facility | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $30.20 / $39.81
| Professional | | $23.99 | $30.20 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Facility | | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $53.70 / $67.61
| Professional | | $17.38 | $53.70 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $28.84 / $58.88
| Facility | | $16.22 | $28.84 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $26.92 / $58.88
| Professional | | $16.22 | $26.92 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $630.96 / $724.44
| Facility | | $436.52 | $630.96 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $31.62 / $56.23
| Professional | | $22.39 | $31.62 | $56.23 |