- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $794.33 / $3,235.94
| Facility | | $87.10 | $794.33 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $741.31 / $1,288.25
| Facility | 50 | $371.54 | $741.31 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $74.13 / $144.54
| Professional | | $43.65 | $74.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $213.80
| Professional | 50 | $66.07 | $107.15 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $95.50
| Professional | | $42.66 | $64.57 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $95.50 / $141.25
| Professional | 50 | $69.18 | $95.50 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $426.58 / $645.65
| Facility | | $134.90 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $72.44 / $104.71
| Professional | | $48.98 | $72.44 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $263.03 / $263.03
| Facility | | $39.81 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $77.62 / $117.49
| Professional | | $50.12 | $77.62 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $501.19 / $1,258.93
| Facility | | $223.87 | $501.19 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $107.15
| Professional | | $41.69 | $61.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $154.88
| Professional | 50 | $85.11 | $85.11 | $154.88 |