- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $389.05 / $1,905.46
| Facility | | $83.18 | $389.05 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $239.88 / $288.40 / $1,122.02
| Facility | 50 | $239.88 | $288.40 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $69.18 / $239.88
| Professional | | $40.74 | $69.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $22.39 / $102.33 / $380.19
| Professional | 50 | $22.39 | $102.33 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Professional | 50 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $933.25 / $1,513.56
| Facility | | $257.04 | $933.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $87.10
| Professional | | $54.95 | $64.57 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $173.78
| Professional | | $47.86 | $77.62 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $93.33
| Professional | | $32.36 | $33.11 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $114.82
| Facility | | $42.66 | $69.18 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $83.18 / $128.82
| Professional | | $48.98 | $83.18 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,148.15 / $1,412.54
| Facility | | $229.09 | $1,148.15 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $79.43 / $125.89
| Professional | | $53.70 | $79.43 | $125.89 |