- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $2,290.87 / $6,456.54
| Facility | | $123.03 | $2,290.87 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $112.20 / $389.05
| Professional | | $54.95 | $112.20 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $97.72 / $323.59 / $354.81
| Professional | 50 | $97.72 | $323.59 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $158.49 / $251.19
| Professional | | $95.50 | $158.49 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $120.23 / $416.87
| Professional | | $58.88 | $120.23 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $194.98 / $2,290.87
| Facility | | $79.43 | $194.98 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $194.98 / $1,148.15
| Professional | | $89.13 | $194.98 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $213.80 / $275.42
| Professional | | $131.83 | $213.80 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $269.15 / $288.40
| Professional | | $144.54 | $269.15 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $95.50 / $186.21
| Professional | | $51.29 | $95.50 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,862.09 / $5,128.61
| Facility | | $1,023.29 | $1,862.09 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $114.82 / $223.87
| Professional | | $60.26 | $114.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $131.83 / $194.98
| Professional | | $107.15 | $131.83 | $194.98 |