- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $1,479.11 / $7,413.10
| Facility | | $102.33 | $1,479.11 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $83.18 / $177.83
| Professional | | $46.77 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $173.78 / $190.55 / $1,380.38
| Professional | 50 | $173.78 | $190.55 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $83.18 / $144.54
| Professional | | $35.48 | $83.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $123.03
| Professional | 50 | $31.62 | $31.62 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $831.76 / $870.96
| Facility | | $218.78 | $831.76 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $114.82
| Professional | | $75.86 | $75.86 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $95.50 / $154.88
| Professional | | $60.26 | $95.50 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $114.82 / $1,288.25
| Facility | | $54.95 | $114.82 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $123.03 / $676.08
| Professional | | $83.18 | $123.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $691.83 / $2,570.40
| Facility | | $467.74 | $691.83 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $83.18 / $123.03
| Professional | | $56.23 | $83.18 | $123.03 |