- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $1,202.26 / $6,456.54
| Facility | | $85.11 | $1,202.26 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $436.52 / $602.56 / $1,819.70
| Facility | 50 | $436.52 | $602.56 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $144.54 / $257.04
| Professional | | $54.95 | $144.54 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $186.21 / $251.19 / $251.19
| Professional | 50 | $186.21 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $138.04 / $302.00
| Professional | | $51.29 | $138.04 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $467.74 / $489.78
| Facility | | $107.15 | $467.74 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $169.82
| Professional | | $81.28 | $81.28 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $125.89 / $234.42
| Professional | | $58.88 | $125.89 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $147.91 / $1,096.48
| Facility | | $54.95 | $147.91 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | 50 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $177.83 / $1,148.15
| Professional | | $109.65 | $177.83 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $380.19 / $1,905.46
| Facility | | $100.00 | $380.19 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $208.93
| Professional | | $61.66 | $102.33 | $208.93 |