- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $95.50 / $10,232.93
| Facility | | $46.77 | $95.50 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $47.86 / $7,244.36
| Professional | | $46.77 | $47.86 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $114.82 / $213.80
| Facility | | $46.77 | $114.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $69.18 / $87.10
| Professional | | $46.77 | $69.18 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $117.49 / $331.13
| Facility | | $48.98 | $117.49 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Professional | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $72.44 / $7,413.10
| Facility | | $46.77 | $72.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $48.98 / $4,466.84
| Professional | | $46.77 | $48.98 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $47.86
| Professional | | $46.77 | $46.77 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $12,882.50 / $14,125.38
| Facility | | $10,471.29 | $12,882.50 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $67.61 / $154.88
| Facility | | $45.71 | $67.61 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Professional | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $48.98 / $74.13
| Facility | | $44.67 | $48.98 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $52.48
| Professional | | $42.66 | $50.12 | $52.48 |