- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $851.14 / $5,128.61
| Facility | | $57.54 | $851.14 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $72.44 / $194.98
| Professional | | $38.90 | $72.44 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $154.88
| Professional | 50 | $72.44 | $104.71 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $58.88 / $77.62
| Professional | | $50.12 | $58.88 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $446.68 / $851.14
| Facility | | $380.19 | $446.68 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $66.07 / $114.82
| Professional | | $44.67 | $66.07 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $56.23
| Facility | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $66.07 / $109.65
| Professional | | $42.66 | $66.07 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $95.50 / $229.09
| Professional | | $54.95 | $95.50 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $48.98 / $77.62
| Professional | | $45.71 | $48.98 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $87.10
| Professional | | $32.36 | $32.36 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $724.44 / $2,089.30
| Facility | | $223.87 | $724.44 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $134.90
| Professional | | $42.66 | $67.61 | $134.90 |