- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $316.23 / $562.34
| Facility | | $51.29 | $316.23 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $77.62 / $144.54
| Professional | | $26.92 | $77.62 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $138.04 / $1,023.29
| Professional | 50 | $33.11 | $138.04 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46,773.51 / $75,857.76 / $95,499.26
| Facility | | $46,773.51 | $75,857.76 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $117.49 / $138.04
| Professional | | $41.69 | $117.49 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Facility | | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $46.77 / $125.89
| Professional | | $21.88 | $46.77 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $102.33 / $158.49
| Facility | | $33.88 | $102.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $102.33 / $158.49
| Professional | | $33.88 | $102.33 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $66.07 / $138.04
| Facility | | $25.12 | $66.07 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $79.43 / $169.82
| Professional | | $37.15 | $79.43 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $72.44 / $162.18
| Professional | | $27.54 | $72.44 | $162.18 |