- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $457.09 / $1,174.90
| Facility | | $91.20 | $457.09 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $758.58
| Facility | 50 | $288.40 | $288.40 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $66.07 / $134.90
| Professional | | $34.67 | $66.07 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $50.12 / $104.71 / $269.15
| Professional | 50 | $50.12 | $104.71 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46,773.51 / $75,857.76 / $95,499.26
| Facility | | $46,773.51 | $75,857.76 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $72.44 / $85.11
| Professional | | $56.23 | $72.44 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $114.82 / $218.78
| Facility | | $56.23 | $114.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $58.88 / $79.43
| Professional | | $45.71 | $58.88 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $100.00
| Facility | | $60.26 | $81.28 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $100.00
| Professional | | $60.26 | $81.28 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $63.10 / $102.33
| Facility | | $42.66 | $63.10 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $104.71
| Professional | | $47.86 | $72.44 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Facility | | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $69.18 / $95.50
| Professional | | $48.98 | $69.18 | $95.50 |