- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $457.09 / $5,370.32
| Facility | | $83.18 | $457.09 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $112.20 / $275.42
| Professional | | $57.54 | $112.20 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $75.86 / $371.54 / $524.81
| Professional | 50 | $75.86 | $371.54 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $169.82 / $288.40
| Professional | | $91.20 | $169.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $416.87
| Professional | | $61.66 | $131.83 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $245.47 / $2,290.87
| Facility | | $89.13 | $245.47 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $223.87 / $1,288.25
| Professional | | $107.15 | $223.87 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $245.47 / $323.59
| Professional | | $144.54 | $245.47 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $218.78 / $245.47
| Professional | | $134.90 | $218.78 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $109.65 / $218.78
| Professional | | $54.95 | $109.65 | $218.78 |
- 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
- $61.66 / $120.23 / $263.03
| Professional | | $61.66 | $120.23 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $147.91 / $223.87
| Professional | | $112.20 | $147.91 | $223.87 |