- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $123.03 / $1,445.44
| Facility | | $40.74 | $123.03 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $131.83
| Professional | | $39.81 | $39.81 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,162.28 / $3,235.94
| Facility | | $3,162.28 | $3,162.28 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $53.70 / $5,011.87
| Facility | | $45.71 | $53.70 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $141.25 / $151.36
| Facility | | $39.81 | $141.25 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $41.69
| Professional | | $39.81 | $39.81 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Professional | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $56.23 / $93.33
| Professional | | $40.74 | $56.23 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $323.59
| Facility | | $53.70 | $53.70 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,162.28 / $3,235.94
| Facility | | $2,398.83 | $3,162.28 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $60.26 / $107.15
| Facility | | $39.81 | $60.26 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $51.29
| Professional | | $39.81 | $39.81 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $67.61 / $74.13
| Professional | | $0.60 | $67.61 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $46.77
| Facility | | $30.20 | $35.48 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $35.48 / $144.54
| Professional | | $17.38 | $35.48 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $41.69 / $50.12
| Professional | | $38.90 | $41.69 | $50.12 |