- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $630.96 / $2,187.76
| Facility | | $87.10 | $630.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 50 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $190.55 / $457.09
| Professional | | $64.57 | $190.55 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $275.42
| Professional | 50 | $194.98 | $245.47 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $81.28 / $281.84
| Professional | | $63.10 | $81.28 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $251.19 / $40,738.03
| Facility | | $128.82 | $251.19 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $128.82 / $223.87
| Professional | | $67.61 | $128.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $102.33 / $194.98 / $338.84
| Professional | 50 | $102.33 | $194.98 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $69.18 / $87.10
| Facility | | $61.66 | $69.18 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $245.47 / $316.23
| Professional | | $199.53 | $245.47 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $478.63
| Facility | | $75.86 | $112.20 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $169.82 / $457.09
| Professional | | $72.44 | $169.82 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $2,290.87 / $7,413.10
| Facility | | $537.03 | $2,290.87 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $177.83 / $407.38
| Professional | | $67.61 | $177.83 | $407.38 |