- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $338.84 / $1,819.70
| Facility | | $83.18 | $338.84 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | 50 | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $93.33 / $316.23
| Professional | | $54.95 | $93.33 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $295.12 / $602.56
| Professional | 50 | $125.89 | $295.12 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,148.15 / $1,819.70
| Facility | | $316.23 | $1,148.15 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $134.90
| Professional | | $70.79 | $97.72 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $104.71 / $229.09
| Professional | | $64.57 | $104.71 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $85.11
| Professional | | $32.36 | $33.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $93.33 / $158.49
| Facility | | $53.70 | $93.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $104.71 / $186.21
| Professional | | $67.61 | $104.71 | $186.21 |
- 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
- $75.86 / $112.20 / $177.83
| Professional | | $75.86 | $112.20 | $177.83 |