- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $4,365.16 / $10,232.93
| Facility | | $87.10 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $123.03 / $457.09
| Professional | | $85.11 | $123.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | 50 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,467.37 / $4,466.84
| Facility | | $1,513.56 | $3,467.37 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $199.53
| Professional | | $87.10 | $134.90 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $213.80
| Professional | 50 | $162.18 | $190.55 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $194.98
| Professional | | $79.43 | $128.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $123.03 / $204.17
| Professional | | $0.21 | $123.03 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $114.82 / $186.21
| Professional | | $0.18 | $114.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $125.89 / $125.89
| Professional | | $75.86 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $1,513.56 / $4,786.30
| Facility | | $70.79 | $1,513.56 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $213.80
| Professional | | $69.18 | $125.89 | $213.80 |