- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $831.76 / $5,623.41
| Facility | | $54.95 | $831.76 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $72.44 / $162.18
| Professional | | $38.90 | $72.44 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $234.42
| Professional | 50 | $72.44 | $104.71 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $61.66 / $85.11
| Professional | | $50.12 | $61.66 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $4,466.84 / $8,709.64
| Facility | | $1,949.84 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $63.10 / $114.82
| Professional | | $34.67 | $63.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $93.33 / $173.78
| Professional | 50 | $52.48 | $93.33 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $43.65 / $50.12
| Facility | | $35.48 | $43.65 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $67.61 / $75.86
| Professional | | $52.48 | $67.61 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $46.77
| Facility | | $38.90 | $38.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $112.20
| Professional | | $40.74 | $63.10 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $2,137.96 / $7,413.10
| Facility | | $257.04 | $2,137.96 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $95.50
| Professional | | $37.15 | $53.70 | $95.50 |