- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $26.30 / $288.40
| Facility | | $16.60 | $26.30 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $70.79
| Professional | | $15.85 | $26.92 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $43.65 / $74.13 / $117.49
| Professional | 50 | $43.65 | $74.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $25.12 / $33.88
| Professional | | $13.18 | $25.12 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,466.84 / $8,709.64
| Facility | | $2,454.71 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $21.38 / $35.48
| Professional | | $16.60 | $21.38 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $25.12 / $31.62 / $53.70
| Professional | 50 | $25.12 | $31.62 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $19.95 / $23.44
| Facility | | $16.22 | $19.95 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $36.31
| Professional | | $25.70 | $33.11 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $21.88
| Facility | | $18.62 | $18.62 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $36.31 / $63.10
| Professional | | $19.05 | $36.31 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $2,137.96 / $7,413.10
| Facility | | $138.04 | $2,137.96 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $32.36 / $56.23
| Professional | | $16.60 | $32.36 | $56.23 |