- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $144.54 / $20,892.96
| Facility | | $35.48 | $144.54 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $46.77 / $89.13
| Professional | | $26.92 | $46.77 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $56.23
| Professional | 50 | $53.70 | $53.70 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $74.13 / $120.23
| Professional | | $46.77 | $74.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Professional | | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $77.62 / $128.82
| Facility | | $45.71 | $77.62 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $128.82
| Professional | | $45.71 | $79.43 | $128.82 |
- 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
- $60.26 / $100.00 / $104.71
| Facility | | $60.26 | $100.00 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $72.44
| Facility | | $69.18 | $69.18 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $75.86 / $131.83
| Professional | | $45.71 | $75.86 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $70.79 / $112.20
| Professional | | $46.77 | $70.79 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $660.69 / $5,754.40
| Facility | | $190.55 | $660.69 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $125.89
| Professional | | $42.66 | $67.61 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $69.18 / $109.65
| Professional | | $57.54 | $69.18 | $109.65 |